the national interest

Obamacare, Public Opinion, and Conservative Self-Delusion

U.S. President Barack Obama (C) is applauded after signing the Affordable Health Care for America Act during a ceremony with fellow Democrats in the East Room of the White House March 23, 2010.
Photo: Win McNamee/Getty Images

One of the more important conservative beliefs about Obamacare, running right alongside the certainty that the law is a disaster that will fail in every respect, is the belief that Americans share their antipathy to the law. It certainly is true that the Affordable Care Act has a bad reputation, and the latest poll showing that support for Obamacare has dipped prompted the same wave of conservative gloating that results from every such poll. But looking even an inch beneath the surface reveals a public more frustrated and confused by Obamacare than opposed. Its specific elements poll well, though they’re the least known elements. Four out of ten Americans don’t realize the law hasn’t been struck down. A new poll out shows that the public, by a ten-point margin, trusts Democrats over Republicans on health-care issues. By a 52–34 percent margin, they want Congress to implement or tinker with the law rather than repeal it. The nearly ubiquitous conservative belief that the public shares its passion for repealing Obamacare is a spate of self-delusion.

That overconfident delusion is the subject of Ramesh Ponnuru’s long National Review essay pleading with conservatives to stop believing their own bullshit. Ponnuru faithfully affirms the general outlines of the right-wing case: Of course the law is terrible, of course it won’t work, of course it must be repealed. He even repeats the misleading line that Max Baucus warned the law would be a “train wreck.” But Ponnuru gently warns that the failure might be slow to arrive, and perhaps not the Greece-esque national catastrophe conservatives have talked themselves into expecting. His account of what conservatives expect to happen, furnished from within the movement, is actually frightening:

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.

A few Republicans who believe that these effects should not be put off: that Americans should suffer them so as to see the failure of Obamacare with their own eyes. Only then will they turn against the law and its supporters with the requisite passion to undo it.

Ponnuru argues that Republicans must also get serious, finally, about replacing the law with something other than the status quo. But there’s a reason Republicans don’t make repealing Obamacare contingent on an alternative plan: Alternative plans that do anything are hard. People get attached to what they have and suspicious of change. Republicans killed Bill Clinton’s health reform by raising the specter that people who have insurance would get something different, which they didn’t trust. The GOP’s only real health-care traction in the 2012 elections came by assailing Obama for cutting Medicare.

Republicans have wisely decided to attack Obamacare without committing themselves to an alternative because the alternative would be easy to attack. Ponnuru, for instance, suggests changing the tax code and stripping regulations to create “a market in which almost everyone would be able to purchase relatively cheap, renewable insurance policies that protected them from the risk of catastrophic health expenses.” Telling tens of millions of Americans they’ll lose their insurance that covers basic medical expenses and get bare-bones policies with thousands of dollars in deductibles is not a winning play.

The Republican war against the implementation of Obamacare is largely an attempt to exploit Amercians’ aversions to change. That’s why the GOP is throwing around wild, inflated claims of “rate shock” — sowing fears that Obamacare will jack up peoples’ health-insurance premiums. The latest party organ to do this is the Republican leadership in Ohio, which is warning its citizens that they will face enormous new costs. (Jonathan Cohn takes apart the shoddy claims.)

The tiny kernel of truth is that a handful of people — mostly young, male, and healthy — will have to buy into some kind of regular insurance plan that covers stuff, not only plans that cover your costs if you’re injured in a car crash and make you pay for just about everything else. The scare campaign could work, at least to some extent. But if it works, it won’t work because Americans are dying to be converted to an all-catastrophic, high-deductible system.

What Republicans have going for them is that health care is really complicated, people don’t spend hours a day boning up on public policy, and those who have insurance understandably fear losing what they have. But the vast majority of the public is not going to see any changes under the new law. Even if the Obamacare exchanges collapse, they only bring in people who don’t have Medicare or employer coverage anyway and are already suffering through a dysfunctional individual insurance market. The “shock” is going to be felt by conservatives who are expecting their Randian fantasies of socialist dystopia to come true.

Obamacare and Conservative Self-Delusion