One of the hard facts about public opinion during the health-care debate was that, while the public quickly soured on health-care reform, it remained quite sweet on the concept of health-care reform. This is why Republican opponents took care to insist at all times they only opposed the particulars of President Obama’s plan, and wanted instead to reform the system their way, with all the popular things and none of the unpopular stuff. Republicans declared they had a “moral imperative” to reform the system, robotically insisting their plan was not merely to repeal health-care reform but “repeal and replace.” As Jonathan Bernstein notes, just last January, Republicans in Congress promised to have their all-gain, no-pain alternative ready and raring to go for the summer so they could move if the Supreme Court overturned Obamacare.
But, in a development that received almost no attention at all, Republicans quietly conceded last week that they aren’t going to replace Obamacare at all.
Insisting they absolutely must replace it was necessary in order to make their totalistic opposition to health-care reform palatable. The political dynamics are such that you can loudly promise to craft an alternative a million times, and then quietly take back that promise in a small article published in The Hill.
Huge majorities of the public support, in the abstract, the idea of universal coverage. But they turn much more negative when presented with specific measures to offset the costs, like taxes or cuts to Medicare. Republicans have been claiming to support the general goal of expanding coverage but simply opposing any specific measure to do so. But conservatives actually oppose the idea of universal health insurance on moral principle. They tend not to concede this straight out, but the belief pops up from time to time.
The central argument against Obamacare was that it cost too much, and, regardless of what the Congressional Budget Office forecast, would doubtless increase the deficit. Paul Ryan has insisted over and over that the cost-control methods put in place by the Affordable Care Act would certainly fail because they entailed bureaucracy. As it happens, health-care costs have slowed dramatically, and there is strongly suggestive evidence that health-care reform has helped drive the slowdown. James Capretta, an adviser to Ryan, wrote a blog post disputing this conclusion. I find his reasoning unpersuasive, but that’s really beside the point. The interesting thing is Capretta’s fallback position, which is that he opposes Obamacare even if it succeeds in controlling health-care costs beyond its most ambitious goals:
... in the unlikely event that we could stop worrying about unaffordable premium increases, federal health spending would still be unaffordable because of the massive rise in enrollment scheduled for Medicare, Medicaid, and Obamacare’s new premium-subsidy entitlement program. There’s no getting around the fact that the federal budget is overloaded with entitlement promises that must be scaled back even if health spending rises only commensurate with the economy.
Is there no getting around the “fact” that the government cannot cover the 50 million uninsured Americans? It’s not a fact at all. It’s an ideological preference. What Capretta is conceding is that the facts don’t matter to him at all. He doesn’t think government should guarantee health insurance as a right. He’ll oppose any universal coverage plan on affordability grounds, but should those grounds prove incorrect, he’ll oppose it anyway.
Likewise, Andrew Ferguson has a piece in the Weekly Standard on an unrelated topic. (Political psychology, if you must know.) Ferguson defends his fellow conservatives’ various misapprehensions, including the misapprehension that Obamacare increased the deficit. In Ferguson’s view, of course it increased the deficit:
It’s perfectly reasonable for conservatives to assume that offering health insurance to 43 million people will cost a lot of money, and thereby increase the deficit; and it’s perfectly reasonable to distrust notoriously mistaken budget forecasters who say it won’t.
Obviously it costs money to cover 43 million people, or even the 30 million people actually covered by Obamacare. But there are ways to offset those costs such that it does not increase the deficit, by raising taxes or cutting other spending, which Obamacare in fact did. Now, it is surely possible that those projections would prove incorrect. But what Ferguson is defending is the supposition that increasing the deficit is an inherent feature of any universal coverage scheme. This obviously is not the case, but his offhand statement is telling. They may debate over the particulars, but the particulars don’t ultimately matter. Conservatives just don’t want to lay out the resources to provide universal coverage. They think of health insurance the way I think of flat-screen televisions — a nice thing to have, and something I’d like everybody to have, but not something to which everybody is entitled. I’d like to see conservatives defend that philosophical position openly rather than couch it in easily cast-aside particulars.