Repeal vs. Reform, Again

Over at NRO, I see that Ramesh Ponnuru is taking exception to my post critiquing his article on the politics of health care repeal. Two points seem to be at issue: the meaning of polling on health care reform, and the value of one particular potential GOP line of attack.

First, the polling.  The problem with the politics of repeal is that repeal would mean elimination of the popular portions of health care reform, along with the unpopular provisions.  Ponnuru, to his credit, acknowledges that problem in his original piece; in fact, it's his first main point.  He argues that the problem of popular provisions can be overcome because there are also unpopular provisions and at any rate what really matters is that the plan polls badly overall. 

On the latter issue, here's Ponnuru's original claim:

Here is what can be said with confidence about the polling...Third, the popularity of some elements of the plan obviously does not stop majorities from disliking Obamacare as a whole.

To which I said:

That last sentence is tricky, no?  One could just as easily say that the unpopularity of reform as a whole doesn't stop majorities from loving the details.  When polling numbers are inconsistent like this it's tempting to believe that the public "really" supports your side of the question, but a more honest approach would admit that neither side can really claim clear public support.  

He now replies:

It is not especially controversial to claim that in the political debate so far, the unpopularity of Obamacare as a whole has overshadowed the popularity of some of its provisions. Liberals know this. They've been complaining about it. I go on to argue that there is no reason to expect this to change. Bernstein presents no counter-argument.

OK, let me try to unpack this a bit.  My original claim is that in cases where public opinion is inconsistent (such as when the public approves of the details but not of an overall plan), it is incorrect to claim that either one is the "true" opinion.  If I understand him correctly, he's basically conceding or at least not contesting that point -- but arguing that my objection is irrelevant, because everyone within the political debate has acted as if it's the "whole plan" numbers that mattered.

If that's his position, he's right that I didn't take it on in my piece.  I shall do so now: it's a foolish argument.   Democrats, of course, did not proceed as if the health care plan was massively unpopular.  You know what they did?  They passed it!  And, in the lead-up to the vote, they talked a lot about how the bill was "really" popular, and trotted out the polling data on individual provisions.  It is true that liberals were not monolithic on this: some liberals believed the bill was unpopular and wanted to give up on it, and it's also true that some liberals believed the bill was unpopular but that the Democrats should pass it anyway.  But the people who counted, at the White House and in the Congressional leadership, said that the bill was popular (that is, they claimed that the individual items trumped the whole bill), and they acted as if it was popular.


So, when Ponnuru says that "It is not especially controversial to claim that in the political debate so far, the unpopularity of Obamacare as a whole has overshadowed the popularity of some of its provisions," then I'd say...well, perhaps at NRO it's not especially controversial.  And of course, before the vote, conservatives thought the bill was dead, because of its supposed unpopularity (the two things I always cite are here and here, but I'll add this one from Ponnuru himself).  But liberals didn't, as it turned out, think that or behave as if the bill was massively unpopular.

If, however, what he's really saying is that the reality of the situation is that the "whole bill" numbers are more revealing than the "individual parts" numbers, then he's wrong, too -- as I think liberals would be if they took the other side of the argument.  What the polls are actually saying is that public opinion on this issue is inconsistent.  There's no way to puzzle out what people "really" think, because what they really think appears to be both.  Or neither.  Or, however you want to express it -- it's both popular and unpopular at the same time.  I do think it's worth pointing out, before leaving this part of the argument, that while the overall plan does poll badly, it's only (currently, according to pollster.com) a six-point gap, which is hardly a decisive margin given all the evidence in the other direction.

Ponnuru's other rejoinder to the problem of repealing popular positions, which I didn't mention in my initial post, is that some provisions are unpopular. 

Second, some elements of the plan poll well in general but others do not. The public does not, for example, seem to be fond either of the cuts to Medicare or the requirement that everyone buy insurance on pain of fine.

That is no doubt correct, but basically irrelevant to the question.  He's advocating a clean repeal ("a simple, one-sentence repeal").  That means a repeal of the popular provisions, which means that if those provisions are in fact popular then people are naturally going to object to a clean repeal.  That's the whole point.  Voters who like some benefits but dislike the overall plan will prefer reform (of the reformed system) to repeal; they will want to keep the stuff they like while getting rid of what they don't like.  Should Republicans press repeal, Democrats (especially since in Ponnuru's repeal fantasy they'll be in the minority and therefore can be irresponsible) will say that the only difference between the Dems and the GOP is that Republicans want to get rid of the good stuff.  After all, they'll say, everyone agrees that the unpopular provisions should be eliminated.  Ponnuru's solution to that is to remind Republicans that the unpopular stuff really is unpopular, but (assuming that's true) how does it follow that voters will be willing to jettison things they like?  I'm sure that paying social security taxes polls badly, too, but that doesn't mean that repealing social security would be a winning position politically.

So much for current polling.  Of course, at some point in the future public opinion may well change, and that's where the remainder of our differences are found.  Generally, I tend to agree with those who say that once benefits are in place, they'll be difficult to dislodge; he, obviously, disagrees.  Doing so requires him to argue -- as, to his credit, he did in the original article -- that seemingly popular provisions will in fact be unpopular as they are implemented.  He did so for the donut hole, for tax credits for small businesses, and for the transitional high risk pools (to deal with pre-existing conditions).  If correct, I think those would be his strongest arguments for the plausibility of repeal.  But I argued that these claims are not convincing.  I found his donut hole and tax credit arguments implausible, and pointed out that even if the high risk pool is unsuccessful, Republicans who advocate permanent high risk pools as a solution to pre-existing conditions will be in the untenable position of arguing for a repeal of (temporary) high risk pools followed by passing new high risk pools, while Democrats can argue that the status quo phases them out in favor of something better (for those with pre-existing conditions, that is), so why repeal?  In response, Ponnuru says that on the donut hole I put too much weight on a scenario that  had "two 'may's and one 'could,'" and basically switches ground, saying: "Bernstein can't imagine how the failure of the first stages of implementation of Obamacare might help Republicans?"

To the contrary.  I certainly can imagine how problems in implementing the ACA could help Republicans; in fact, in my post, I say that I don't think that even a successful health care reform will necessarily help the Democrats.  But of course Ponnuru's original piece wasn't about whether reform will help the Democrats or the Republicans this year; it was ostensibly about the feasibility of flat-out repeal.  For repeal, it's not enough to argue that ACA in general will be unpopular.  What one needs to believe -- what I thought Ponnuru was arguing in the original piece -- is that voters will want to get rid of the entire thing.  Repeal will open up the donut hole; repeal will eliminate tax credits to small businesses; repeal will (once the bill is fully implemented) eliminate subsidies to those buying insurance on the individual market through the new exchanges; and repeal will once again allow insurers to avoid those with pre-existing conditions.  If those provisions are popular, a simple repeal won't fly -- even if people dislike the system overall. 

In other words, if it is to be taken seriously, the case for repeal really does need an argument that those seemingly popular items will in fact prove to be unpopular.  Especially since (as Ponnuru again acknowledged in the original piece) most of the unpopular provisions are only in there because they are necessary for the popular stuff to work.  That he tried to make that case is to his credit.  That it was, in my view, so weak -- and that he didn't even bother trying to defend it in his response to my critique -- reveals just how untenable repeal really is. 

Just to be clear: I'm not claiming that the Democrats will be helped in this election cycle by the health care law they passed (I suspect so, a little, but I'm far more comfortable saying that we don't know).  I explicitly said that I don't think that having passed ACA helps the Democrats in the long run.  I'm also not predicting that the new law will be popular (again, I don't know).  I am predicting two things.  I suspect that once it is implemented, many provisions of the new law will seem uncontroversial, just part of the regular way things are.  And that as a result, flat-out repeal, the one-sentence repeal Ponnuru is championing, is not going to happen.  Moreover, while I suppose it might be popular as a slogan in a Republican primary, repeal is a terrible issue for Republicans in competitive general elections. 

In other words, I don't know whether the new health care system will turn out to be popular or unpopular.  Either way, however, it sure seems to me that Republicans are going to have to find some position other than simple repeal.