21
Jan
10

Why is ObamaCare so despised?

(You might think that I’m still writing about the Massachusetts Senate election, but I’m not.  In fact, I’m gearing up for a proper Glib Dilettante run at American health insurance, health-care reform, and whatever version of the current health-reform bill is around by the time I start poking at it.  I’m gonna do my best to do it with a careful and open mind, and a bottomless supply of bipartisan vitriol.  On with the show!)

If we believe Nate Silver — and he’s rather clever, so I don’t know why we wouldn’t — the national political environment contributed about as much to Coakley’s defeat as did Coakley herself:

Overall, we have a 31-point swing in the vote to explain: from Barack Obama’s roughly 26-point victory in November 2008, to Martha Coakley’s roughly 5-point loss today.

At a bare minimum, 10 of those points must be assigned to the national environment. Generic ballot polling suggests that the Democrats’ position has worsened by a net of 10 points since November 2008, from winning the House popular vote by 10 points in 2008 to being dead even with Republicans today.

[…]

If you follow through on the math, this would suggest that Coakley would have won by about 8 points, rather than losing by 5, had the national environment not deteriorated so significantly for Democrats.

“The national environment” encompasses a lot of things, but I will be dipped in shit if ObamaCare isn’t a major — probably the major — contributing factor.  (I think it’s somewhat unfair to call the present health-care reform bill “ObamaCare”, given that it’s been hacked to pieces and reassembled by a thundering herd of politicians, lobbyists, and special interest groups who aren’t Obama, but I guess when you’re the President you’re an easy target for blame.  Sounds familiar.)  The stated goals of health-care reform are thus:

  1. Make health insurance affordable for everyone, not just people with jobs that provide it
  2. Reduce the cost of health care

(As we begin this epic journey of discovery glib dilettantism, I am thoroughly in support of 1. and deeply skeptical of 2. Just so you know.)

How could anyone object to those goals?

I submit that nobody — or at least a vanishingly small group of people — actually objects to either 1. or 2. in and of themselves.  Rather, I suspect that the vast rejection of the health-care reform bill — as of today, RCP’s average of polls suggests that 40.2% favour the bill, and 49.7% oppose it — comes down to the way its implementation is being presented and perceived.

For a bit of context, have a look at this email to Andrew Sullivan:

There is so much joy in middle America today. There’s hope that Obama won’t succeed in ruining our way of life. And the bitter irony for the liberal elite: after a year of mocking the Tea Party people as ignorant, redneck “teabaggers,” it’s precisely those “common” folks who smash the whole Obama project. It’s priceless. I’m so happy that I’m going to have dinner at Denny’s and then drink a few Budweisers. You have some quiche and write some more about how stupid we are.

and especially this post by LabRat:

Rural and suburban proles don’t have pickup trucks to tote around their crosses, lighter fluid, and lynching victims, they have them to tote around the tools and materials with which manual labor is done, and the fact that Olbermann apparently can’t even wrap his head around that enough to connect it to work and to class rather than attach it as a nebulous symbol of a racist “underclass” is a picture-perfect illustration of why they don’t trust him and the governing class he represents.

[…]

Barack Obama is impossible to picture in a pickup truck, but that’s not about the color of his skin, it’s about his class. His educational credentials are Ivy League, and so are his wife’s. They may be darker than past Presidents, but they came from the exact same culture as the entrenched governing class.

(Incidentally, I called this one right after the 2008 election.  It was pretty obvious to anyone who cared to look, but I’ll pat myself on the back anyway:

This contemptuous patrician attitude isn’t just the most annoying feature of the present Democratic party, it’s probably also their greatest weakness.  So much of the American identity is founded on the idea of fundamental equality between people that any hint otherwise could prove disastrous.  I don’t expect the Dems themselves to address this, either: after clinching the Presidency, the House, and the Senate in this election, I expect them to be firmly in the grip of “victory disease”.

Damn I’m good.)

Basically, I think J. Random Massachusetts Protest Voter saw ObamaCare as an expensive and onerous programme to tell “middle America” — you know, the folks bitterly clinging to guns and religion — what to do, with unwarranted and unfair rewards for political allies and special interests.  I’m not interested in arguing about how true that is*, but I can see how it’d come across that way.

Let’s start off with the talk about surtaxes on”Cadillac” health-insurance plans.  Intended as a sop to the CBO (“how’re we gonna pay for this, anyway?”) and a piece of raw chickenshit populism (“soak the rich!”), I think it got people worried about what health-care reform would do to their insurance.  When it came out that a lot of union insurance plans would qualify for the Cadillac surcharge, those people got even more suspicious: this wasn’t about increasing access to health insurance, but increasing parity of health insurance.  Just as surely as those without would be dragged up, reasoned these people, those with would be dragged down.  I’ve heard numbers like 30 million to 45 million uninsured Americans; that means that 85% to 90% of Americans are insured, and that’s a large block of voters who might get pissed off.

(How many people really would be affected by the surtax?  I have no idea, but I’m going to make a wild-assed guess of 5% to 15%.)

Furthermore, the individual mandate gave people the (entirely correct) impression that there would be no opting out of the system.  Do the horror stories of health insurers — now with bonus surtaxes — turning into the equivalent of the local DMV scare you more than the idea of going broke paying for chemo?  Tough shit, buddy: Nancy Pelosi thinks it’s “very fair” to throw you in jail if you don’t get on board with her programme.  And what most people know about jail, they learned from Oz — so if HCR turns into a cataclysmic clusterfuck, their other option is getting raped by skinheads.

But shouldn’t some of the provisions of the health-care reform bill benefit everyone? Maybe, but those 85%-90% may be skeptical anyway:

For the majority of voters who get insurance through their employers, the downsides of the overhaul have became increasingly tangible while the promised benefits – among them lower costs – have seemed increasingly nebulous.

[M]ost of the bills’ provisions are targeted at the more than 30 million Americans lacking coverage and the 17 million people who buy insurance in the individual market. The bills would bar insurers from rejecting individuals with health problems and would guarantee that policies couldn’t be cancelled if enrollees got sick. But such promises seem hypothetical for many people who already have jobs and insurance – the very constituency the Democrats need to succeed.

So if popular imagination has it that everyone’s going to be herded into the health-insurance equivalent of an unfinished concrete Soviet apartment building, who gets the luxurious dachas in the woods?

This is where the back-and-forth hog-trading and influence-buying came to the forefront.  An individual mandate without a public option?  Sounds like a great deal for the health insurance companies — a perception that was reinforced when the bill’s backers declined to remove the health-insurance exemptions from the McCarran-Ferguson Act.  Without tort reform, cost reduction basically amounts to Medicare cuts (which were already scheduled, though postponed) — which looks an awful lot like trial lawyers getting theirs at the expense of doctors and hospitals.  (Who likes lawyers, anyway?)  Those are just the first two examples that come to mind.

And that’s just the mechanics of the bill.  The supposedly-critical 60th vote came from Nebraska Senator Ben Nelson, whose support was bought with “a promise that the federal government would pay forever for extra poor people to join Medicaid in Nebraska.”  Nelson’s vote tipped the balance; Nelson’s vote is the one that everyone remembers; and Nelson’s vote had to be bought at the expense of the other forty-nine states.  The big HCR news just before the Massachusetts election?  Unions would be exempt from the Cadillac surtax.  That’s enough to piss off the anti-labour crowd, but the exemption lasts a mere two years — enough to keep rank-and-file union members nervous.

Basically, if you were suspicious of the health-reform bill the first time around, this iteration gave you plenty of excuses to believe that it would make things worse for you, while the special interests and arrogant elitists in Washington feathered their own nests at your expense.  It’s a matter of fairness, which is a great way to get people riled up well past the point of lost reason.  In MA in particular, Coakley’s sneers about Fenway Park and Obama’s sneers about pickup trucks were probably frighteningly effective at reinforcing the polarized perception of “power-grubbing elite” vs. “regular Middle America folks”.

(Incidentally, I think a lot of the people who support health-care reform have the same view of the current system: that the elite and powerful get lavish care beyond their needs, while the rest of the country suffers.)

It’s not what the bill was designed to do, it’s how it got there.

——

* Yet

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2 Responses to “Why is ObamaCare so despised?”


  1. January 21, 2010 at 12:54

    “It’s not what the bill was designed to do, it’s how it got there.”

    Indeed! Great minds think alike: http://theincidentaleconomist.com/the-death-of-legislation/


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