“They Won’t Be Moving On”: What Will Republicans Do if Obamacare Turns Out OK?
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
“Pinhead Density Arguments”: There Was A Reason Conservatives Once Supported The Individual Mandate
Of all the arguments being waged over the Affordable Care Act — or, as the Obama campaign now likes to refer to it, “Obamacare” — the one dominating the Supreme Court this week is perhaps the most conceptually trivial.
The individual mandate requires consumers to purchase health insurance in order to eliminate the problem of free riders — people who don’t purchase insurance until they get sick or injured or those who never purchase insurance and end up passing on to the rest of us the costs of care they can’t afford. Detractors argue that the mandate unconstitutionally infringes on personal liberty by forcing Americans to purchase health insurance. But compare it to three ways of addressing the free- rider problem in health care that are clearly, indisputably, constitutional:
• Single payer: The federal government increases income taxes and, in return, guarantees everyone government-provided health-care insurance. There is no option to opt out of the taxes. This is how most of Medicare works, though the insurance kicks in only after you turn 65.
• Late-enrollment penalty: The single-payer approach only holds for “most of” Medicare because the Medicare Prescription Drug Benefit works a bit differently. For every month that you don’t enroll after becoming eligible at age 65, your premium rises by one percentage point.
• Tax credits: Under various health-care proposals — including the plan of Rep.Paul Ryan (R-Wis.) — the tax code is changed to give families a tax credit for purchasing private health insurance. Families that choose to go without insurance, or simply can’t afford it, would not receive the tax credit.
All of these plans share the same basic approach: They impose a financial penalty, either before or after the fact, on those who forgo health insurance. Single payer does it through taxes, Medicare Part D through premiums and Ryan’s plan through tax credits.
Now consider the individual mandate. Here’s how it works: Starting in 2016, those who don’t carry insurance will be annually assessed a fine of $695 or 2.5 percent of their income, whichever is higher.
Skeptics of government should clearly prefer the individual mandate to single payer. In fact, the individual mandate was developed by conservative economist Mark Pauly as an alternative to single payer. “We did it because we were concerned about the specter of single-payer insurance, which isn’t market-oriented, and we didn’t think was a good idea,” Pauly told me last year. In the 1990s, the individual mandate was also the Republican counterproposal to President Bill Clinton’s health-care bill, and in 2005, it was the centerpiece of Massachusetts Gov. Mitt Romney’s health-care reforms.
The Medicare Part D model doesn’t really work as an alternative to the individual mandate because it requires the federal government to set the cost of premiums. That’s possible with the over-65 set, because the government controls the market. To import that idea to the under-65 market, however, would require vastly more governmental intrusion into the health-care space.
The tax credit, meanwhile, is essentially indistinguishable from the mandate. Ryan’s plan offers a $2,300 refundable tax credit to individuals and a $5,700 credit to families who purchase private health insurance. Of course, tax credits aren’t free. In effect, what Ryan’s plan does is raise taxes and/or cut services by the cost of his credit and then rebate the difference to everyone who signs up for health insurance. It’s essentially a roundabout version of the individual mandate, which directly taxes people who don’t buy health insurance in the first place.
“It’s the same,” says William Gale, director of the Tax Policy Center. “The economics of saying you get a credit if you buy insurance and you don’t if you don’t are not different than the economics of saying you pay a penalty if you don’t buy insurance and you don’t if you do.”
Interestingly, Ryan’s plan imposes, if anything, a harsher penalty on those who don’t purchase health insurance. Ryan’s tax credit is far larger than the individual mandate’s penalty, and much easier to enforce. Under Ryan’s plan, if you don’t purchase insurance, you don’t get the credit. End of story. Conversely, the Affordable Care Act doesn’t include an actual enforcement mechanism for the individual mandate. If you refuse to pay it, the IRS can’t throw you in jail, dock your wages or really do anything at all.
This leads to one of the secrets of Obamacare: Perhaps the best deal in the bill is to pay the mandate penalty year after year and only purchase insurance once you get sick. To knowingly free ride, in other words. In that scenario, the mandate acts as an option for purchasing insurance at a low price when you need it. For that reason, when health-policy experts worry about the mandate, they don’t worry that it is too coercive. They worry that it isn’t coercive enough.
The mandate is considered more effective than tax credits because people seem more inclined to take action to avoid penalties than to receive benefits. That’s worked extremely well in Massachusetts, for instance, where there’s been almost no free-rider problem at all. So while it’s not different as a matter of economics, it’s a bit different as a matter of behavioral economics. In that way, the mandate does a little more to solve the free-rider problem with a little less action from the government.
Randy Barnett, a conservative law professor at Georgetown University, agrees that there’s some similarity between the two approaches. But he warns that that doesn’t make them legally equivalent. “Just because the government does have the power to do X, doesn’t mean they have the power to do Y, even if Y has the same effect as X,” he says. “There’s no constitutional principle like that.”
Although that’s true, it also leaves us in a peculiar spot. The constitutional argument over Obamacare is a dispute over a technicality. We agree that it’s constitutional for the government to intervene far more aggressively in the market. We agree that it’s constitutional for it to intervene in an almost identical, albeit slightly more roundabout, manner. We’re just not sure if the government needs to call the individual mandate a “tax” rather than “a penalty,” or perhaps structure it as a tax credit. As Pauly puts it, “This seems to me to be angelic pinhead density arguments about whether it’s a payment to do something or not to do something.”
Of course, this battle isn’t really about the constitutionality of the individual mandate. Members of the Republican Party didn’t express concerns that the individual mandate might be an unconstitutional assault on liberty when they devised the idea in the late 1980s, or when they wielded it against the Clinton White House in the 1990s, or when it was passed into law in Massachusetts in the mid-2000s. Indeed, Sen. Jim DeMint (S.C.), arguably the most conservative Republican in the Senate, touted Romney’s reforms as a model for the nation. Only after the mandate became the centerpiece of the Democrats’ health-care bill did its constitutionality suddenly become an issue.
The real fight is over whether the Affordable Care Act should exist at all. Republicans lost that battle in Congress, where they lacked a majority in 2010. Now they hope to win it in the Supreme Court, where they hold a one-vote advantage. The argument against the individual mandate is a pretext for overturning Obamacare. But it’s a pretext that could set a very peculiar precedent.
If the mandate falls, future politicians, who will still need to fix the health-care system and address the free-rider problem, will be left with the option of either moving toward a single-payer system or offering incredibly large, expensive tax credits in order to persuade people to do things they don’t otherwise want to do. That is to say, in the name of liberty, Republicans and their allies on the Supreme Court will have guaranteed a future with much more government intrusion in the health-care marketplace.
By: Ezra Klein, The Washington Post, March 31, 2012
“Picking And Choosing”: The Church, Taxes, And Health Insurance
The other day Tim Noah used the occasion of the Senate’s vote on allowing any employer to prevent their employees’ insurance from covering anything and everything the employer doesn’t like (which every Republican senator except Olympia Snowe voted for) to argue that this is yet more evidence that employers ought to get out of the business of providing health coverage, and we ought to just have the government do it. In a single-payer system, these kinds of decisions can be made by our democratic process, and not by every employer individually.
There’s just one note I want to make about this. Conservatives have been talking a lot about the importance of preserving the “conscience” of the Catholic Church, their right not to participate in anything that violates their beliefs. That, of course, is a privilege that the rest of us, being citizens of a democracy, don’t enjoy. We pay taxes, which go to a lot of things we dislike. I don’t like the fact that our government spends as much on the military as every other nation on earth combined. I also don’t like the money we spend on tax subsidies for oil companies. My conservative friends don’t like the fact that the government gives food stamps to poor people, and pays the EPA to make sure our air and water are clean. But we all pay taxes, because that’s how it works—we don’t get to pick and choose each line item we want to pay for and which ones we don’t.
The Catholic Church, on the other hand, like all religious institutions, doesn’t pay taxes. Nor do their affiliated organizations like hospitals and universities, because they are nonprofit organizations. So if we had a single-payer system, the Church wouldn’t be involved in anybody’s insurance. The only way they could influence the law would be the way they do on other issues now: not by demanding that the law give them yet more special treatment, but through their moral persuasion on how they think the rest of us should act. And you can imagine how much force that would have.
By: Paul Waldman, The American Prospect, March 5, 2012
“The South Lost”: The Historical Misunderstanding At The Root Of Modern Republican Philosophy
There’s a basic, historical misunderstanding at the root of modern Republican philosophy. A little fact that seems to get overlooked. It’s not their insistence that the road to fascism begins with good health care. It’s not even the pretense that President Obama somehow masterminded an economic collapse, bank bailout, and massive deficit weeks, months or years before he came into office. No, the incident that the GOP has let slip is a little more basic.
The South lost.
See, Republicans seem to have mistaken “wage slavery” for … that other kind of slavery. They must have, because anyone who understood that workers are employees, and not property, would recognize that workers have rights. Not just some rights, not a neatly restricted little subset of rights, but the same rights as the people who employ them. They would recognize that the rights of an employer do not include the ability to abridge the rights of an employee.
Only they don’t. When you see Mitt Romney or Rick Santorum or John Boehner railing against government overstep on religion, conscience, what-have-you, you can be 100 percent certain that their concern is that somewhere, somehow an employer might have to allow his employees to do something that, you know, miffs them. That millions of employees might be forced to do without needed health care … doesn’t enter into the equation.
It’s easy to see how employers might be confused, considering all the love being lavished on them by both parties, and with the paeans being sung to them as magical “job creators.” And hey, we already pretty much handed over that fourth amendment to them, what with peeing in a cup or being able to fire people because of an old photo on Facebook. Republicans have been busy reinforcing that lesson by insisting that anyone who collects so much as an unemployment check should be subject to any rules they want to set. It’s no wonder that the line between handing someone a paycheck, and holding someone’s title, should have gotten blurred.
So consider this a primer to the confused American business owners and executives who might have listened just a little to long to all that sweet praise.
As an employer, you have the absolute right to religious freedom. Attend any church, temple, synagogue or reading room you like. Give as you feel obligated. Worship as you please. Place on yourself any restriction in diet, activity or anything else that you feel is in keeping with your beliefs … but only on yourself. You don’t get to impose these restrictions on your employees.
Your employees are separate from you. Not only that, they are equal to you in rights, no matter how unequal you may be in income. You do not get to tell them who to vote for. You do not get to tell them who they can love. You do not get to use your religious beliefs as an excuse to limit their health care.
No matter how strong your personal faith, your employees are not obligated to live according to those beliefs, expressly because they are personal. You may find it frustrating, but your employees have just as much right to their own beliefs as you do to yours, and whether you pay them pittance on an assembly line or six figures as a manager, you have zero right to carve off a slice of their freedom. The direction of the pay arrow has no effect on who gets to dictate to who.
If the government was telling you, as an individual, that you had to use birth control, that would be a violation of your rights. That’s not happening. They’re just saying that you don’t get to make that decision for the people who work for your company. Because, really, you don’t own them.
If you’re still mad; if you’re upset that healthcare has to be funneled through employers at all … there’s a cure for that. It’s called “single payer.”
By: Mark Sumner, Daily Kos, February 19, 2012
The Republican “Need for Greed” Meets the Fockers
The bet was audacious from the beginning, and given the miserable, low-down tenor of contemporary politics, not unfathomable: Could you divide the country between greedy geezers and everyone else as a way to radically alter the social contract?
But in order for the Republican plan to turn Medicare, one of most popular government programs in history, into a much-diminished voucher system, the greed card had to work.
The plan’s architect, Representative Paul Ryan of Wisconsin, drew a line in the actuarial sand: Anyone born before 1957 would not be affected. They could enjoy the single-payer, socialized medical care program that has allowed millions of people to live extended lives of dignity and decent health care.
And their kids and grandkids? Sorry, they would have to take their little voucher and pay some private insurer nearly twice as much as a senior pays for basic government coverage today. In essence, Republicans would break up the population between an I’ve Got Mine segment and The Left Behinds.
Again, not a bad political calculation. Altruism is a squishy notion, hard to sustain in an election. Ryan himself has made a naked play for greed in defending the plan. “Seniors, as soon as they realize this doesn’t affect them, they are not so opposed,” he has said.
Well, the early verdict is in, and it looks as though the better angels have prevailed: seniors are opposed. Republicans: Meet the Fockers. Already, there is considerable anxiety — and some guilt — among older folks about leaving their children worse off financially than they are. To burden them with a much costlier, privatized elderly health insurance program is a lead weight for the golden years.
This plan is toast. Newt Gingrich is in deep trouble with the Republican base for stating the obvious on Sunday, when he called the signature Medicare proposal of his party “right-wing social engineering.” But that’s exactly what it is: a blueprint for downward mobility.
Look at the special Congressional election of next Tuesday. What was supposed to be a shoo-in for Republicans in a very safe district of upstate New York is now a tossup. For that, you can blame the Medicare radicals now running the House.
And a raft of recent polls show that seniors, who voted overwhelmingly Republican in the 2010 elections, are retreating in droves. Democratic pollster Geoffrey Garin says the Ryan plan is a “watershed event,” putting older voters in play for next year’s presidential election.
Beyond the political calculations, all of this is encouraging news because it shows that people are starting to think much harder about what kind of country they want to live in. Give the Republicans credit for honesty and showing their true colors. And their plan is at least a starting point compared with those Tea Party political illiterates who waved signs urging government to keep its hands off their government health care.
When the House of Representatives voted to end Medicare as we know it last month, it was sold as a way to save the program. Medicare now covers 47.5 million Americans, but it won’t have sufficient funds to pay full benefits by 2024, according to the most recent trustee report. Something has to be done.
Many Republicans want to kill it. They hate Medicare because it represents everything they are philosophically opposed to: a government-run program that works and is popular across the political board. It’s tough to shout about the dangers of universal health care when the two greatest protectors (if not creators) of the elderly middle class are those pillars of 20th-century progressive change, Social Security and Medicare.
For next year’s election, all but a handful of Republicans in the House are stuck with the Scarlet Letter of the Ryan Plan on their record. Soon, there will be a similar vote in the Senate. It will not pass, but it will show which side of the argument politicians are on.
There is a very simple way to make Medicare whole through the end of this century, far less complicated, and more of a bargain in the long run than the bizarre Ryan plan. Raise taxes. It hasn’t sunk in yet, but most American pay less taxes now than anytime in the last 50 years, according to a number of measurements. And a majority of the public now seems willing to pay a little extra (or force somebody else to pay a little extra) to keep a good thing going. Both Ronald Reagan and George H.W. Bush raised taxes, by the way.
Given a choice between self-interest and the greater good, voters will usually watch out for themselves — unless that greater good is their own family. For Republicans intent on killing Medicare, it was a monumental miscalculation to miss that logical leap.
By: Timothy Egan, Opinion Writer, The New York Times, May 17, 2011
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