What’s Behind the Rate-Shock-Victim Obsession

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Photo: CHRIS KLEPONIS/2010 AFP

Last week, the Obamacare war room detected a twist in the national narrative that concerned them. The media’s obsessive focus on the failed website launch was beginning to give way to stories about individuals who found higher-than-expected prices on the exchanges. A memo instructed participants to prepare for such “media inquiries”: “The media attention will follow individuals to plan selection and their ultimate choices; and, in some cases, there will be fewer options than would be desired to promote consumer choice and an ideal shopping experience,” warned the memo. “Additionally, in some cases there will be relatively high-cost plans.”

CNN’s Jake Tapper obtained the memo. Here is how he described it: “Officials expressed concern that the next shoe to drop in the evolving story about the Affordable Care Act would be disappointment from consumers once they are able to get on the troubled Healthcare.gov website — disappointment because of sticker shock and limited choice.” Notice the crucial difference in framing. The memo simply acknowledged that in some cases — a caveat that appeared twice — consumers would have fewer options and higher prices than the administration would like. In CNN’s characterization, the caveat disappears altogether. Tapper portrays the problem as “disappointment from consumers,” writ large. The minority facing sticker shock has become a stand-in for the entire public.

This turns out to be a synecdoche for the entire Obamacare narrative now. The world of the Republican Party’s fever dreams has sprung to life in the mainstream media, where the Affordable Care Act now exists primarily as a series of cruel, oppressive acts of theft against innocent Americans. Here are CBS News, The Wall Street Journal, and the Washington Post chronicling the parade of horribles.

The stories often turn out to be either more complicated than initially depicted, or wildly overblown. But it is surely true that some people will find themselves worse off, at least immediately, under the new law. That their fate has blotted out everything else about the law explains why health-care reform is so maddeningly difficult to enact in the first place.

Everybody knows about the two main ways in which the American health-care system is awful: It’s the most expensive in the world, by far, and also the only advanced health-care system that denies basic care to many citizens. There’s also a third awful trait as well: The system is resistant to change. The very insecurity of American health care, the ever-present fear of finding one’s insurance lifeline snapped and plunging into the howling void of the 50 million uninsured, renders those with insurance understandably terrified of change.

The Affordable Care Act worked around the inherent change aversion of the system by leaving the vast majority of it in place. Insuring tens of millions of Americans costs money, and that money has to come from somewhere, but the law’s author’s carefully apportioned the burden in a relatively painless way. Some of the money comes from higher taxes on the rich — a source of anger and resentment on the right, though conservatives have shrewdly recognized that complaining about higher taxes on wealthy investors to pay for covering the uninsured is not a winning message. Some of the it comes from reshuffling Medicare spending, so that the government essentially shifts funds from reimbursing hospitals for treating uninsured patients in emergency rooms to basic medical care, a clear positive-sum transfer.

And, yes, some of the cost is borne by the minority of healthy individuals paying higher premiums. (These individuals will, of course, go from Obamacare victims to Obamacare beneficiaries the moment anybody in their household develops a serious medical condition, in the same manner that fire insurance is a bad deal for people whose houses don’t burn.)

Why has their plight attained such singular prominence? Several factors have come together. The news media has a natural attraction to bad news over good. “Millions Set to Gain Low-Cost Insurance” is a less attractive story than “Florida Woman Facing Higher Costs.” Obama overstated the case when he repeatedly assured Americans that nobody would lose their current health-care plan. There’s also an economic bias at work. Victims of rate shock are middle-class, and their travails, in general, tend to attract far more lavish coverage than the problems of the poor. (Did you know that on November 1, millions of Americans suffered painful cuts to nutritional assistance? Not a single Sunday-morning talk-show mentioned it.)

The point here is not that Obamacare represents a perfectly optimal restructuring of the health-care system. Almost nobody would regard it as such. The point is that it represents the least-disruptive, least-painful way to clear the minimal threshold of any humane reform. The preferred alternatives of both right and left would impose an order of magnitude more dislocation — creating not a few million “victims,” but tens of millions. What’s on display at the moment is a way of looking at the world that sanctifies defenders of the horrendous status quo and places all the burden upon those trying to change it.