Monday, September 26, 2011

The Obamacare/ACA split

I said this Friday, but I sort of buried it in a longish post with lots of other things, so I'm glad that Scott Lemieux gives me a chance to be clearer. He's a longtime Mitt Romney pessimist who (like Jonathan Chait) realizes that Romney could very well win, and he doesn't get it:
[I]t’s still amazing that someone who lost a race against zero serious orthodox conservatives is poised to win a race with a more conservative primary electorate while in the interim his signature public policy has become absolutely toxic to said electorate.
My response to this has always been that the GOP electorate doesn't actually care about health care reform the same way it cares about, say, abortion or taxes on rich people. Or, as I'm now putting it, Republican voters strongly oppose Obamacare, but they don't care very much about the ACA. They strongly oppose the health care plan that Barack Obama and Nancy Peloci and  Harry Reid crammed through Congress against the will of the American people, and they think it's an unconstitutional power grab that amounts to a government takeover that's going to bankrupt the nation by cutting Medicare and death panels and all. But they don't know or care anything about the exchanges, or the cost-cutting efforts, or most of the rest of it.

And that being the case, the similarities between the Massachusetts plan and ACA are pretty much irrelevant -- what matters is whether the Massachusetts plan is similar to Obamacare (that is, to a government takeover supported by Barack Obama with death panels and the rest). And it's not all that hard for Romney to deflect that, at least for those who are open to his candidacy otherwise. Because, of course, Romney can claim that he's 100% against Obamacare and 100% for fully repealing it, and mumble mumble jargon jargon it's totally different from what he was up to when he was governor.

Again, it's certainly possible that Republican party actors who oppose Romney for other reasons will settle on health care as the best way to convince voters he's unreliable. And if voters hear from GOP opinion leaders that Romney supported something identical to Obamacare, then they may turn against him based on that -- not because they inherently hate Romney's health care plan, but because they trust GOP opinion leaders. But as an attack from other candidates without the support of other leading conservatives, I've never thought that it's a very strong charge, because Romney can always respond with just as much disdain as the other candidates that he strongly opposes Obamacare and would repeal it as soon as possible.

Because, after all, Mitt Romney does hate Obamacare. He just doesn't really hate the ACA, but Republicans don't much care about that.


  1. I completely agree with this post. I can't recall if I made the argument previously, but IMHO, when a Republican speaks of "Obamacare", they are referring to the inevitable progression to Euro-style socialized medicine. The ACA is a wholly separate entity.

    I'm not even confident this distinction reflects right-wing ignorance. I'm not sure if someone much smarter than I, say perhaps Ezra Klein, has made this point, but it seems as though the ACA is pretty close to what the private health insurance industry would have come up with to expand their customer base to the full nation. Not exactly - e.g. removal of caps/pre-existing condition limitations - but pretty close.

    So while the ACA arguably satisfies the criteria of extending coverage to ~all 300 million Americans, its still quite a long way from the progressive ideal of universal socialized medicine.

    That's the ideal that Republicans are disparaging with the term "Obamacare". ACA has little if anything to do with that; for that matter, neither does Romney's Massachusetts plan.

  2. I've gotten several e-mails from my right-wing dad pointing out all the evils associated with ObamaCare: the government will have access to all your electronic bank accounts, and illegal immigrants must be covered, that sort of thing. I don't look all that closely at them, but I've never seen any objection to the ACA that is actually true.

    Aside from the mandate, I've never seen or heard of any Republicans attacking the ACA on any sort of truthful or substantive level, including their presidential candidates. That's kind of a big deal, isn't it? It's as if the 2004 Democratic presidential candidates all claimed that the Bush tax cuts eliminated all taxes on income over $250,000, and the media reacted as if that was a legitimate viewpoint.

  3. The thing is, I haven't heard a single Republican opinion-maker adopt Romney's position that Obamacare and Romneycare are fundamentally different, much less argue in favor of the plan itself. On the contrary, every Republican opinion-maker who has addressed the subject has called out Romney's distinction as phony and unconvincing. And it's not something they've tried to ignore either. It seems to be the main thing that has earned him a reputation in this cycle as a moderate, non-Tea Partier. (In contrast, most of the GOP opinion-makers in the 2008 election depicted him as a "true conservative" unlike those fakers, McCain and Huck. There was occasional grumbling about his abortion flip-floppery, but that was about it.)

  4. The term "Obamacare" came into use, though, in the course of protests over the ACA. The signs at the rallies and town halls in August 2009 didn't say "ACA Yes, Obamacare No" or anything like that. The "death panels" charge was launched against a (misinterpreted) provision of the ACA.

    In other words, we're dealing here with abysmal ignorance. In fact this post strikes me as a fairly searing indictment of the "Madisonian" system, if this is the kind of policy confusion it makes possible. In Britain, there are regular debates over health care, and there has been one going on lately over a somewhat complex plan to partly privatize some NHS services. But these are discussed, as far as I can see, as a complex plan to partly privatize some NHS services. You don't have Britons, let alone the political leaders and candidates there, going around denouncing "Cameroncare" or "Lansleycare" while agreeing with the actual plan.

  5. To me this is basically persuasive but also too cute by half. Obamacare and ACA may not be the same thing, exactly, but in principle it should have been a useful hammer for his opponents to bludgeon him with; it's been noted that Romney's utterances on the matter haven't been very convincing, which may be part of Jonathan's point. I don't know. The Republicans in the primary have thus far seemed uniquely incompetent at campaigning, and (as Lemieux said) that has been Romney's luck. My take is that the Republicans just don't have a strong bench, they don't have any quality candidates around to run against Romney. This partly ties into the new face of the Republican Party that shuns moderates and takes batshit, extreme positions demagoguing everything. It's not a fertile environment for a more effective Romney type to prosper -- this is basically the reason Romney is still doing well. We'll see how the Mormonism plays in later on -- and, IMO, the Obamacare issue. He's not the nominee yet.

  6. A couple of interesting pieces on this:

    The always-solid Marc Hetherington:

    A grad student at UCLA argues Obamacare racializes opinions:

  7. So what is the defining feature of Obamacare that Republicans oppose to the point that their state attorney generals have filed lawsuits asking for the ACA to be thrown out as un-Constitutional? Oh yeah it's the individual mandate -- also a core part of Romneycare. If Perry et al can't use that effectively against Romney, they are either uniquely incompetent or it's further just proof that there is almost no policy content to most people's voting decision. It's all about demographics, who-would-I-like-to-have-a-beer-with, and how's the economy doing for me.

  8. Let me clarify...I do think that Republicans more or less oppose ACA; I just don't think they care about any of it very much. Why a lawsuit based on the mandate? Because the lawyers told them that's what was available.

    And I definitely don't think this is true on all issues. If a GOP candidate defended a prior pro-choice record the way that Romney has defended the MA plan, he'd be totally dead. Same with gun control, and other things that conservatives really care about.

  9. Isn't it more plausible that a lot of Republican opposition to ACA/Obama-care is substantive, but they feel uncomfortable openly saying what they dislike: 1) the expansion of coverage to poor people in the form of subsidies which are 2) paid for by higher taxes on some less poor people? That structure conflicts with some fairly fundamental Republican beliefs. And it's even something that many Democratic politicians soft-pedaled out of fear about public opinion.

    It's easier as well as more socially and politically shrewd -- that is, in a variety of ways, less outwardly aggressive -- to act as if the greatest imposition of the Democrats' welfare goal is the individual mandate.

  10. Basically I think you might be misreading the coding of phrases that actually do bespeak an accurate appraisal of why they see the law as a threat: it is simplistically speaking more "government," and the associations of that term in many Republican politicians and voters' vocabulary is "stuff that benefits undeserving poor people."

  11. Oh, I wouldn't get too excited about Romney right now, and yes, ObamaCare is what will eventually put him down.

    Sorta like ObamaCare's currently putting down about a dozen lefty US senators who voted for it, and who are fighting for their electoral lives as a result. When 5-10 of them get whacked in November 2012, ObamaCare will be a big reason, just like it was for last Fall's wipeout. And there'll be another crop in 2014 who will face the music, as well.

    Romney simply has no base of support, and what support he has is rooted not 1" deep. Remember, he couldn't defeat McCain, and McCain was one of the most despised men in America, and still is. Even people who voted for him didn't like him. And the rest of us didn't vote for him.

    Some ObamaCare news today, it appears Obama's not gonna stall the SC's review of ObamaCare, so next year he'll either get a yes on ObamaCare and a personal policy win and political loss (the voters are still gonna hammer him over it), or he gets a no on ObamaCare, and accepts a personal policy loss but scores a political win (ObamaCare gets removed as a millstone around his neck and he gets to campaign on health care reform again, plus the SC nominations and some assorted other stuff).

    Obama's best political outcome is for ObamaCare to get scrapped. He should have asked the Congress to dump it 6 months ago. It's not popular, the people reject it, and it's only going to continue to erode the Left's political fortunes as long as it's around. Conversely, nothing would help his political fortunes and the Left's more than ditching ObamaCare. It would be a godsend for them. It'd give them something to campaign around, rather than Obamanomics, which isn't going over too well right now.

    I don't see him as politically astute or brave enough to make such a call, however, and this decision to bring on a quicker SC ruling seems to confirm that.

  12. Look, whatever substantive similarities exist between Romneycare and the ACA, the crucial difference is intent. There is a strong, conservative, capitalist case to be made for something like Romneycare, on the basis that a growing underclass of uninsured/uninsurable puts pressure on the polity's economy from several directions. Romney's solution isn't a terrible way to get there; perhaps the reason Republicans don't hate it is because it's actually fairly conservative.

    While the ACA, as a specific piece of legislation, is also fairly conservative (and thus similar to Romney's plan), no one - no one - believes that the ACA is anything other than a progressive beachhead toward the left's ultimate goal of full socialized medicine. Where do conservatives get that idea? Maybe from every single progressive in America who has weighed in on the ACA, saying exactly that?

    So when Jeff says that conservatives are "abysmally ignorant" for not taking the ACA at face value, one wonders: when has a progressive ever taken the ACA at face value, instead of discussing it as a beachhead?

    Indeed, while the co-opting of the term Obamacare to mean socialized medicine may be frustrating to the left, I think it was actually fairly shrewd on the part of the right wing. Because conservatives don't hate an ACA when it comes from a Romney-like intent, but in the hands of progressives, the ACA presages things that conservatives hate.

    Where do conservatives get the "presage" idea?

    Progressives have told us so several million times.

  13. CSH, those are very good points, but I actually think you underestimate the sincerity with which many conservatives/Republicans hate the idea of Obamacare/Romneycare. Romney supported it because he was doing what seemed judicious within the contraints of the fairly liberal state of Massachusetts. He wouldn't have pushed for that measure for deep intellectual reasons in any political environment; it was a tactical acceptance of semi-defeat. Just as during the Clinton administration many Republican politicians and think tanks pushed for Romneycare-like health insurance programs as a tactical measure so that they could say they had an idea besides Clinton's program, in order to block it. They weren't going to push for major health insurance reform without political pressure. Under many American conservatives' worldview then, and now most American conservatives' worldview today (thanks to further radicalization), the health care/insurance situation doesn't register as a human *welfare* problem; it's a problem when government has to cover costs. That's why conservatives actually sincerely accept Paul Ryan's ideas and why less high-information conservatives have no apparent problem with the idea of Ryancare when it's implicitly framed as preventing undeserving parts of the population from mooching off the rest of society.

  14. A good number of Republican intellectuals and politicians continued to support the individual mandate idea into the 2000s, long after Clinton's initiative had failed. Several Republican senators like Hatch and Grassley were on record as supporting the mandate as late as the spring and early summer of 2009. I believe that this was their sincere intellectual position, and that the anti-mandate position they adopted in the summer of 2009 was insincere. Admittedly, with the Republican Party moving to the hard right, Grassley and Hatch are not representative of current Republican politicians.

  15. Jonathan,

    I think you are right, in fact my intuition tells me that you are not only right but this is an important point and illustrates the gap between much of what the GOP says and the underlying message they are conveying to their constituency and that their base is feeling.

    For example its rare that one hears those opposed to the ACA discuss many of the particulars or accept what the consequences of a repeal would mean. The IPAB is a symbolic element that represents the intrusion of government though its on the side of cost control. They play the freedom angle/government intrusion angle versus the cost angle whenever one works over the other. I believe for example that the bulk of the opposition to the IPAB is the fear that it might work and bring Medicare spending much more under control.

    Many thanks for this important point.

  16. CSH, I would not necessarily disagree with your analysis. I think a lot of the people who were/are screaming about "Obamacare" would not have objected if President Romney had proposed essentially the same reforms in 2009. They would trust a moderate Republican to be aiming merely to correct market failures in a private-industry-friendly way, while they assume that a moderate Democrat doing exactly the same thing, especially if he is of the less-white persuasion, is nefariously intent on taking us one step closer toward his imagined Marxist utopia. OK.

    But my point is that this does not reflect well on the political system that our host here regularly defends (and insists, perhaps understandably, on calling "Madisonian" although its main architect was John Rutledge, but never mind that now). It means that there's no serious policy discussion or understanding driving public opinion, just hyper-partisan tribalism and sloganeering. I don't expect politics to be a graduate seminar in public policy, but at some point we cross (or have crossed) a line beyond which elections no longer give us any guidance as to what the people want their government to do. Do they want insurance companies to be able to cherry-pick and preclude people with pre-existing conditions, or not? Do they want some kind of affordable insurance available outside of old-style employment benefits, or not? Do they want a national arrangement that's available to them regardless of what state they live in, or not? If the answer is, "We want those things, but not if the duly elected president and Congress try to provide them," then we're dealing with..... I don't know, maybe not "abysmal ignorance" but something equally destructive of any sort of sustainable democracy.

  17. "Isn't it more plausible that a lot of Republican opposition to ACA/Obama-care is substantive, but they feel uncomfortable openly saying what they dislike: 1) the expansion of coverage to poor people in the form of subsidies which are 2) paid for by higher taxes on some less poor people?"

    But we won't need to raise taxes to pay for ACA, remember? It's "revenue-neutral"!

  18. With all the heat that Romney takes over the Massachusetts plan, I sometimes wonder why he doesn't make the obvious response. Arguments regarding how much a government should become involved in medical care, like so many other political disputes, really have nothing to do with right or wrong. They have to do with what the people see as a legitimate role for government. The people of Massachusetts apparently wanted quite a bit of government involvement, and were willing to pay for it. Romney helped to give them what they wanted. The people of the country as a whole seem to be not so sure. Romney could with a clear conscience both take credit for his Massachusetts plan and resist imposing such a plan at the national level.

  19. can we move onto what is *really* bothering the gop base ?
    my personal view is that they bought into the right wing view that free market capitilism and 401Ks would be a cornucopia, and now that it is failing, they are , as psychologists would know, not admitting that liberals are right, but doubling down.

    I think also, for people of my age (55 or so) there has been a huge, huge loss of "freedom" in this country since the '60s- the freedom to disapear from paper and gov't and so on, reinvent your life, leave behind your identity and rent an apt for cash and be new..
    there are a lot more people; what use to be wide open space is now mc mansions or the well tended lawns of the rich (my parents to me to cape cod in the 60s, and when i went backin the 90s, my memory of sand dunes was confronted with acres of houses...)

    I dunno, but I think we aren't talking about what is really bothering the base.

    a lot of it could be homophobia, which they know they can't talk about in public

  20. Obamacare and ACA are absolutely the same thing. Research before you blog.


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