One of the hoariest debates in recent politics, revived by Mitt Romney’s highly selective quotations from Noam Scheiber’s recent book, is whether the Obama administration lost an opportunity to further stimulate the economy when it decides to devote so much attention and political capital to the enactment of the Patient Protection and Affordable Care Act of 2010.

This argument remains ridiculous coming from Republicans, since they opposed Obama’s economic policies as violently as they did his health care policies. But it’s a claim you also hear often on the Left, including, as a matter of fact, from Noam Scheiber.

But as Harold Pollack explains at Ten Miles Square, the “false choice” of health care versus the economy is particularly suspect if you look at the stimulative effect health reform might have produced had it been designed a bit differently:

The real missed opportunity was the failure-forced by fiscal conservatives at both ends of Pennsylvania Avenue-to embed more effective and immediate help for states, localities, and ordinary people in the nuts and bolts of the final bill. Health reform included many opportunities for a second stimulus. Many of these opportunities were missed, due to the tentative back-loading of the Senate bill that became the core of the Affordable Care Act.

Suppose ACA had included a five-year extension to the COBRA subsidies embedded in the 2009 stimulus. Imagine if ACA had abolished the mandatory Medicare waiting period for individuals who qualify for federal disability programs. Imagine if the bill had allowed each state the option to begin health insurance exchanges as soon as these could possibly be implemented. Imagine if ACA had continued the 2009 stimulus’s highly-favorable federal matching rates for hard-pressed state Medicaid programs.

Each of these measures would have been sound health policy. Each would have accelerated the on-the-ground implementation of health care reform for ordinary people. The Affordable Care Act’s original sin, tentative back-loading of its main pillars, left health reform more politically vulnerable than it needed to be. It also left on the table needed opportunities to provide immediate help to a weak national economy.

When the final accounting of the Obama administration is written, Harold’s what-might-have-been should become more than a footnote.

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Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.