Ramesh Ponnuru has a long piece at National Review imploring conservatives to come up with a health-care plan they can swiftly put in place when Obamacare inevitably collapses under the weight of its disastrous big-government delusions. Though I disagree with almost every point Ponnuru makes along the way, from his analysis of what will happen with Obamacare to his recommendations of what a conservative health-insurance system should look like (the fact that anyone, even a free-market dogmatist, thinks catastrophic coverage plus high-risk pools would work out great is just incredible), I’ll give him credit for trying to get his ideological brethren to come up with a proposal to solve what they themselves keep saying is a terrible problem. But alas, his effort is doomed to fail. Why? Because when it comes to health care, conservatives just don’t care. I’ll elaborate in a moment, but here’s the crux of Ponnuru’s argument:
Opponents of Obamacare should plan instead for the likelihood that in its first years of full operation the law will fail in undramatic and unspectacular ways. Premium increases, cost overruns, and the like may keep the law from becoming popular, but they will not prompt the third of the public that supports it to switch sides, or even get its many soft opponents fired up about it. Meanwhile, the administration will spend millions of taxpayer dollars to advertise the law’s benefits. The law’s dogged defenders will explain away all the disappointing developments, and the polls, as the result of continuing opposition in red states. A few conservative lawmakers have speculated that the law will crash so badly that the Democrats will themselves demand repeal in the next couple of years. That is not the way to bet.
Republicans’ confidence that Obamacare will collapse has contributed to their lassitude in coming up with an alternative. It is a perverse complacency. If the program were going to collapse in the next three years, it would be all the more important for Republicans to build the case for a replacement for it. We can be sure that the Left would respond to any such collapse by making the case for a “single payer” program in which the federal government directly provides everyone insurance.
The biggest problem with this kind of appeal is that he will never, ever get anything beyond a tiny number of Republicans to invest any effort in coming up with a health-care plan. That would involve understanding a complex topic, weighing competing values and considerations against one another, and eventually getting behind something that will be something of a compromise. And let me say it again: They. Just. Don’t. Care.
That isn’t to say there are no conservatives who care about health care, because there are a few (like the folks at the Heritage Foundation who came up with the individual mandate!). But they are few and far between on the right. Your typical Republican, on the other hand, cares deeply about issues like taxes and defense policy, and works hard to understand them and come up with ideas for where they should go in the future. But had President Obama not passed health-care reform, they would have been perfectly happy to let the status quo continue indefinitely. They donned their fervent opposition to Obamacare like a new jacket, for reasons of politics, not policy. Sure, it was in many ways a conservative plan, much of whose complexity comes from the fact that it works to expand coverage within the private market. But it was big and important, and it was Obama, and it was a way to articulate their anti-government philosophy, and so they got fired up about it. But it isn’t because health-care policy is something they’re passionate about. Republicans care about taxes whether or not at the moment we happen to be having a big public debate about taxes. But if we weren’t debating health care, they wouldn’t be staying up nights coming up with interesting solutions to health-care problems, because it just isn’t their thing.
Ponnuru doesn’t allow for the possibility that Obamacare will turn out to be something less than a total failure, and he says that conservatives all believe the same thing (though he does differ from some of his allies on whether it will collapse dramatically or simply limp miserably along). But let me suggest another possible scenario: It ends up working pretty well. It doesn’t turn America into a health-care paradise, and there are some implementation problems here and there, and we still have to pay more for our system than other countries do. But people like the fact that their coverage is guaranteed, and the doomsaying turns out not to be borne out. Critically, the middle class and wealthy people who collectively hold political influence discover that their lives haven’t really been changed all that much, except in some ways that are positive. And it becomes hard to get voters too angry about Obamacare.
What will Republicans do then, if the issue doesn’t seem to have much political potency? Will they keep working to come up with new health-care proposals more in line with their values? Or will they move on to some other issues that seem to offer better opportunities to gain political advantage? If you think it’s the former, you’re dreaming.
By: Paul Waldman, Contributing Editor, The American Prospect, June 13, 2013
“Obamacare Is Killing The GOP”: Republicans’ Opiate Obsession With The Law Will Be The Party’s Undoing
It’s not an exaggeration to say Republicans have bet their future on the disaster they expect from Obamacare. “The implementation of the law over the next year is going to reveal a lot of kinks, a lot of red tape, a lot of taxes, a lot of price increases,” RNC spokesman Brad Dayspring told The New York Times last month. “It’s going to be an issue that’s front and center [in 2014].” GOP intellectuals see Obamacare as the centerpiece of the party’s strategy even well beyond then. “Republicans are likely to seize on every sad [implementation] story as justification for dramatic changes—and in 2016, mount campaigns designed to replace the system in whole or in part with plenty of material to use in their cause,” the conservative wonk Ben Domenech wrote approvingly in March.
And, of course, the party’s base is completely, unremittingly, obsessed with the issue. The mere anticipation of an implementation quagmire is “reinvigorating the movement,” Jenny Beth Martin, a national Tea Party official, told The Hill in early May. “We’re doing street rallies and protests over the next month to three months, initially. We’re working to recruit candidates that can talk about this.”
I happen to be agnostic about whether health care implementation will help the GOP in 2014. On the one hand, anything that energizes conservatives in a low-turnout election should benefit Republicans, much as it did on 2010. On the other hand, as The Washington Post’s Greg Sargent points out, much of the public antipathy toward Obamacare is already baked into the polls. The people who disapprove haven’t liked it from the get-go; similarly for the people who approve. It’s possible that a series of implementation snafus will move those numbers at the margins—a new poll suggests public opinion has soured a bit lately, perhaps as a result of all the “train wreck” chatter. On the other hand, it’s also possible that implementation will go relatively smoothly and people will embrace the program, netting Democrats a few more votes.
What I do know is that the GOP’s health care preoccupation is absolutely destroying its long-term prospects. However well the issue may work in the midterms, when an uptick in conservative turnout can flip a few dozen House seats, 2012 proved that it’s at best a wash in a presidential election, when Democrats can swamp that turnout with their demographic edge, and when the GOP’s challenge is to win moderates and independents as a result. Conservatives argue that the only reason health care didn’t work in 2012 is that Romney was a flawed messenger, given his patrimonial link to Obamacare. But with the Supreme Court largely blessing the law last June, the issue was mostly settled in the public mind, making it at best a non-factor among swing voters.
Even if implementation goes terribly, it isn’t likely to rekindle widespread angst. Most people will be untouched by implementation—even a disastrous implementation—for the simple reason that they won’t be relying on Obamacare. As Bloomberg’s Josh Barro has explained, 78 percent of us get coverage through Medicare, Medicaid, or our employers, a figure isn’t likely to change very much, or at least very quickly. Meanwhile, my colleague Jonathan Cohn points out that life for many people who do end up on Obamacare will improve, however flawed the program is, because it translates into insurance they didn’t have before.
Having said all that, the real problem with conservatives’ Obamacare strategy isn’t that it won’t work. It’s that the Obamacare obsession is actively sabotaging the GOP. Earlier this week The Washington Post ran an article about the ongoing dysfunction among House Republicans. Easily the most telling anecdote had to do with a largely symbolic measure called the Helping Sick Americans Now Act, concocted by Majority Leader Eric Cantor to help Republicans look like they care about the problems of ordinary people. (The bill feinted at easing the lot of the uninsured.) That, apparently, is where Cantor erred. As the Post explains:
A few dozen Republicans opposed the modest Helping Sick Americans legislation because they said it came from nowhere. Instead, Cantor pulled the bill and held another vote to repeal Obamacare — their 37th attempt to repeal part or all of the landmark health-care law — to appease conservatives.
To put the problem in Marxian terms, Obamacare has become the opiate of the GOP. By its own admission, the party must broaden its appeal to Latinos, gays, and young voters. It needs an economic agenda that encompasses more than tax cuts for the rich and brutal spending cuts. It has to persuade voters it’s more than just a nihilistic force bent on triggering global financial apocalypse if it doesn’t get its way in Washington. And yet, when party leaders so much as broach these liabilities, conservatives revolt and the leadership caves, appeasing them with an issue whose political utility peaked two-and-a-half years ago. (Suffice it to say, after the last few years, the words “reinvigorating the Tea Party movement” won’t exactly help Cantor and Boehner sleep at night.)
If you want to appreciate how truly incorrigible conservatives are on the subject, I recommend watching them grapple with the early news about Obamacare implementation, which has suggested the program could work better than anticipated. It’s a bit like watching a speculator learn he’s bet his life savings on a failing company—which is to say, chock full of denial and elaborate self-delusion.
For example, in late May, when the head of California’s insurance exchange announced that insurers were submitting cheaper bids than the state expected (and cheaper than many critics predicted), the conservative columnist Avik Roy tried to disprove the claims by visiting an online clearinghouse for private insurance plans. Roy solicited bids for a healthy 25-year-old male and a healthy 40-year old male, then pointed out that they came in far below what coverage would cost through the Obamacare exchange. All fine and good, except that Roy’s hypothetical bids were neither here nor there. The point of Obamacare is to provide affordable insurance to people who may be sick or older.
Alas, the fact that Roy basically affirmed the rationale for a program he set out to discredit—healthy, affluent young people are the one group that will do worse under Obamacare; everyone else will do better; no one has ever disputed this—didn’t stop every conservative outlet on the Internet from trumpeting his analysis. “Obamacare drives up insurance premiums by up to 146 percent in California,” screamed The Daily Caller. Even after a succession of wonks highlighted the glaring flaws, the editorialists at The Wall Street Journal leaned on Roy to declare an “ObamaCare Bait and Switch.”
The desperation here is palpable, but also understandable. If, instead of trying to fix your party’s deepest pathologies you wagered its entire future on a high-risk strategy that was starting to turn bad, you’d be a little desperate, too. Perhaps it’s a subset of Obama Derangement Syndrome that afflicts conservatives when they talk about health care—call it Obamacare Derangement Syndrome. Maybe one day, once the dust has settled, it’ll be covered under Obamacare, too.
By: Norm Scheiber, Senior Editor, The New Republic, June 7, 2013
“No Shedding Crocodile Tears Here”: Obamacare Critics Should Stop Using Young Men To Fuel Their Arguments
In January, one of Obamacare’s most controversial provisions will come into effect:
Every person in America will be required to either have health insurance or pay a penalty.
Overall, the effect will likely be a net positive: Because of subsidies, the cost of insurance will be kept down for many households, and in many states, a Medicaid expansion will help even more families pay for their health care. But while the outlook is great for millions of workers, things are going to be tougher for at least one group: healthy, financially secure men in their twenties.
So, guess which group Obamacare critics have focused on when they attack the effects of the program? I’ll give you three guesses, but you’ll probably only need one.
On Wednesday, New York magazine’s Jonathan Chait pointed out the surprising trend, noting that critics of the Affordable Care Act have almost universally cited the group in their attacks. Likening the move to an old-time patent medicine show (“You, sir – the healthy 25-year-old in front who has never been hospitalized or needed medication in his life! Step right up!”), he suggested that the attacks on Obamacare are, to put it mildly, skewed.
On the surface, targeting the law’s impact on healthy 25-year-old men seems like a masterstroke. After all, it’s hard to argue for the fairness of a system that charges healthy young people to pay for the health care needs of sickly older ones. The trouble is, today’s healthy 25-year-old male could easily become tomorrow’s hit-and-run victim, desperately in need of long-term medical care. And, barring that, today’s healthy 20-something will, with any luck, become a less-healthy 50-something, in need of an affordable method to cover his medications and regular doctor’s visits.
(Or, as happened to me when I was an uninsured man in my mid-20s, today’s healthy young 25-year-old could be tomorrow’s guy paying out-of-pocket for wisdom teeth extraction.)
Obamacare has numerous provisions that will extend coverage and make health insurance cheaper. Among other things, it will help cover the Medicare Part D coverage gap, will end exclusions for pre-existing conditions, and will require health care plans to cover preventative care.
For tens of millions of people, these provisions, and others, will translate into lower medical costs, a previously unimaginable access to health care, and a generally improved quality of life. Given the huge potential benefits, maybe it’s time for Obamacare’s critics to stop shedding crocodile tears for the relatively small portion of the populace that is going to have to take one for the team — and, in the process, get insurance that may well make them safer and healthier.
By: Bruce Watson, Business Insider, Originally Published in DailyFinance, June 10, 2013
In politics, we often skip past the simple questions. This is why inquiries about the fundamentals can sometimes catch everyone short.
Michael Lind, the independent-minded scholar, posed one such question last week about libertarianism that I hope will shake up the political world. It’s important because many in the new generation of conservative politicians declare libertarianism as their core political philosophy.
It’s true that since nearly all Americans favor limits on government, most of us have found libertarians to be helpful allies at one point or another. Libertarians have the virtue, in principle at least, of a very clear creed: They believe in the smallest government possible, longing for what the late philosopher Robert Nozick, in his classic book “Anarchy, State, and Utopia,” called “the night-watchman state.” Anything government does beyond protecting people from violence or theft and enforcing contracts is seen as illegitimate.
If you start there, taking a stand on the issues of the day is easy. All efforts to cut back on government functions — public schools, Medicare, environmental regulation, food stamps — should be supported. Anything that increases government activity (Obamacare, for example) should be opposed.
In his bracing 1970s libertarian manifesto “For a New Liberty,” the economist Murray Rothbard promised a nation that would be characterized by “individual liberty, a peaceful foreign policy, minimal government and a free-market economy.”
Rothbard’s book concludes with boldness: “Liberty has never been fully tried in the modern world; libertarians now propose to fulfill the American dream and the world dream of liberty and prosperity for all mankind.”
This is where Lind’s question comes in. Note that Rothbard freely acknowledges that “liberty has never been fully tried,” at least by the libertarians’ exacting definition. In an essay in Salon, Lind asks:
“If libertarians are correct in claiming that they understand how best to organize a modern society, how is it that not a single country in the world in the early 21st century is organized along libertarian lines?”
In other words, “Why are there no libertarian countries?”
The ideas of the center-left — based on welfare states conjoined with market economies — have been deployed all over the democratic world, most extensively in the social democratic Scandinavian countries. We also have had deadly experiments with communism, a.k.a Marxism-Leninism.
From this, Lind asks another question: “If socialism is discredited by the failure of communist regimes in the real world, why isn’t libertarianism discredited by the absence of any libertarian regimes in the real world?”
The answer lies in a kind of circular logic: Libertarians can keep holding up their dream of perfection because, as a practical matter, it will never be tried in full. Even many who say they are libertarians reject the idea when it gets too close to home.
The strongest political support for a broad anti-statist libertarianism now comes from the tea party. Yet tea party members, as the polls show, are older than the country as a whole. They say they want to shrink government in a big way but are uneasy about embracing this concept when reducing Social Security and Medicare comes up. Thus do the proposals to cut these programs being pushed by Republicans in Congress exempt the current generation of recipients. There’s no way Republicans are going to attack their own base.
But this inconsistency (or hypocrisy) contains a truth: We had something close to a small-government libertarian utopia in the late 19th century and we decided it didn’t work. We realized that many Americans would never be able to save enough for retirement and, later, that most of them would be unable to afford health insurance when they were old. Smaller government meant that too many people were poor and that monopolies were formed too easily.
And when the Great Depression engulfed us, government was helpless, largely handcuffed by this anti-government ideology until Franklin D. Roosevelt came along.
In fact, as Lind points out, most countries that we typically see as “free” and prosperous have governments that consume around 40 percent of their gross domestic product. They are better off for it. “Libertarians,” he writes, “seem to have persuaded themselves that there is no significant trade-off between less government and more national insecurity, more crime, more illiteracy and more infant and maternal mortality . . . .”
This matters to our current politics because too many politicians are making decisions on the basis of a grand, utopian theory that they never can — or will — put into practice. They then use this theory to avoid a candid conversation about the messy choices governance requires. And this is why we have gridlock.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, June 9, 2013
House Republicans are launching a coordinated campaign against Obamacare, hoping to emphasize the negative effects of the health law to their constituents at upcoming town hall meetings. At the same time, however, they’re fully prepared to tell those same constituents to enjoy all the benefits available to them under health reform — ultimately taking advantage of Obamacare funding in their home districts.
As Politico reports, several of the GOP members of the new coalition — called the “House Obamacare Accountability Project,” or HOAP — went on the record to confirm they will help their constituents figure out how to get the benefits funded through the health reform law. The Republicans said that if they’re asked, they will help people get access to the insurance premium subsidies or the Medicaid coverage that’s available to them under Obamacare. “That’s an important part of constituent services,” Rep. Kevin Brady (R-TX) explained.
They’re not the only lawmakers who have advocated for getting rid of the health law even while simultaneously enjoying its benefits. As Lee Fang reports in the Nation, several anti-Obamacare Republicans like Sens. John Cornyn (R-TX) and Rob Portman (R-OH) have requested grants funded through the health reform law for their districts. GOP lawmakers who decry Obamacare in public have requested Obamacare money to bolster their states’ health clinics, extend health services to uninsured residents, and launch public health campaigns.
In their letters requesting Obamacare funds, Republican lawmakers have praised the positive long term effects of the health reform law’s initiatives. Cornyn wrote that a grant from the Affordable Care Act would “improve the health and quality of life of area residents.” In reference to the same grant, Rep. Michael McCaul (R-TX) called the effort a “crucial initiative to achieve a healthier Houston/Harris County.” Rep. Aaron Schock (R-IL) praised a local nonprofit for winning Obamacare funds that will help give “people the tools to live healthier and longer lives.”
That reflects a larger trend when it comes to Obamacare: Although Americans may say they oppose the health law as a whole, they support its individual provisions. That seeming contradiction may partly be thanks to GOP-led initiatives like HOAP. Since political controversy has swirled around the health reform law for the past three years, Americans remain confused about what Obamacare actually does — and over 40 percent of the public isn’t even sure whether it’s still law.
By: Tara Culp-Resseler, Think Progress, June 7, 2013