As healthcare.gov slowly lurches into functionality, the battle lines around the health-care law are returning to their pre-October state. Giddy conservative hopes for the law’s immediate disintegration, or its quick repeal, have ebbed, and in their place opponents have returned to hoping that the law will fail because not many people will want to buy health insurance. Ross Douthat warns, or perhaps fantasizes, that the immediate collapse may have been averted, but the long, slow collapse may yet beckon on the horizon.
The new-old mechanism for the law’s predicted demise is that only the sickest or poorest Americans will enroll — “the law can work only if people who don’t necessarily benefit immediately from its provisions decide to participate anyway,” argues Douthat. But this is a misguided understanding of how insurance works and why people want it, a point that has been demonstrated most convincingly by the eagerness of the toughest Obamacare customer base you can imagine: congressional Republicans.
The still-fresh GOP messaging about the failed website launch turns out to be highly instructive. As part of their message campaign, Republicans in Washington, and their staffers, made displays of their difficulties, or alleged difficulties, enrolling in the new exchanges. For instance, Representative Chuck Fleischmann complained about the website freezing, and being forced to pay high premiums.
Why is he going through the bother and financial cost? “I am not a fan of Obamacare,” Fleischmann told Politico. “But I was bound and determined to try to comply with the law. I’ve done everything in my power to try to do that.” That is an awfully strange way to put it. Remember, a Supreme Court ruling reduced the individual mandate to a mere tax, and Fleischmann could comply with the law by paying a small fee for going without insurance. Instead he is enrolling anyway.
And of course the great hope of the conservative movement has been to foster a massive boycott of the exchanges – burn your (imaginary) Obamacare card, pay the tax instead. The Koch brothers are paying activists to flood college-football tailgate parties, plying undergraduates with free pizza and beer so they’ll listen to their pitch to boycott the exchanges. The Weekly Standard has an unintentionally comic reported dispatch from one such effort in South Bend, Indiana, where conservative activists attempt to drum up enthusiasm among frigid, demoralized Notre Dame undergraduates (“‘If this was a sunny day, this would be packed. Everyone would have their Opt-Out stickers on,’ said Matt Zepeda, a junior.”)
Even as they try to goad Americans into following the boycott, conservative activists themselves have blithely ignored it. Salon’s Brian Beutler fruitfully trolled Amanda Carpenter, a speechwriter and senior communications adviser for Ted Cruz, over Carpenter’s high-profile complaints about the slowness of the health-care site, producing this head-smacking confession:
@brianbeutler And how am I not required to enroll? This is my only option for employer care and I don't want to be uninsured.— Amanda Carpenter (@amandacarpenter) November 29, 2013
I don’t want to be uninsured. When even as fanatical an ideological cadre as Ted Cruz’s speechwriter blurts her desperation to join Obamacare, it suggests that conservatives have deeply miscalculated.
The problem here is that their definition of who would “benefit” is exceedingly narrow. You “benefit,” by his way of thinking, only if your actuarial costs exceed your financial contributions. But that isn’t how most people think about insurance. Insurance isn’t a kind of gamble where you bet you can beat the house by consuming more in medical care than you pay in premiums and deductibles. It’s protection from risk. People like that protection. They will pay to acquire it.
None of this is to say that the exchanges will quickly and seamlessly fill with desperate customers. It will remain a glitchy, halting process filled with bureaucratic aggravation — much as private insurance has been until now. The botched website rollout gave conservatives a powerful weapon to batter the credibility of Obama and his eponymous law. But the short-term benefits of website bashing also lured them into confessing the hopelessness of their long-term plan.