Sunday, November 10, 2013

The Republican Dilemma on Obamacare

Actually, there are several.  To take the simplest, what are Republicans to make of all these stories about how badly it is going.  After all, it is a Republican article of faith the the media have a hopeless liberal bias and would never speak an ill word about Obama.  And now they are doing it.  This one is a relatively easy dilemma to overcome.  You simply conclude that the exchanges are so disastrous that eventheliberalmedia can't ignore them, and that if eventheliberalmedia are reporting problems with Obamacare, think how much worse reality must be.  Actually, this shows media bias, all right, but of a different sort.  In particular, it shows a bias toward bad news.  People signing up and everything going well just isn't much of a story.

Next problem:  What to do about it.  Yes, it is tempting to gloat over the failed exchanges, but to actually get indignant that the exchanges are not working well is to suggest that you want them to work well.  Cancelled policies and increased rates fit well with the narrative of Obamacare being a disaster.  Exchanges working badly makes it sound like a basically good idea, badly executed.  And if you get too indignant over exchanges not working it leaves another, obvious problem -- what if they do start working.  Then what will  you do?

And then there are the opponents trying to convince healthy young people not to sign up so as to induce a death spiral.  Yes, there are some who warn that the death spiral is inevitable, but plenty of others don't see it as quite so inevitable that they are doing their best to bring it about.  In effect, they are urging young people not to buy health insurance so we can bring the whole system crashing down, and all those older and sicker people will lose their health insurance.  Hurray!  Wait a minute, why did we want all those older and sicker people to lose their health insurance?  My guess is that most people wanting to crash the system haven't thought that far ahead and just want to get at Obama.  Nonetheless, there are three sort of coherent answers:
  1. The simply oppose all state-mandated systems of redistribution, in this case, from the healthy to the sick.  They want to keep the healthy from being "enslaved" by the sick (i.e., subsidizing them).  That it will induce a death spiral is an entirely unintended side effect.  Except that enough people have made perfectly clear that they are, indeed, deliberately trying to create a death spiral that this argument is just not convincing.
  2. They want to avoid all state-mandated redistribution and keep the healthy from being "enslaved" by the sick.  That the sick will lose their coverage as a result is simply not a legitimate public policy concern.  Only ensuring that there is no state-mandated redistribution is a legitimate public policy concern.  The need of any potential recipients is not.  But once again, deliberately seeking to engineer a death spiral certainly makes it seem like you want beneficiaries to lose their health insurance.
  3. People who didn't get health insurance when they were young and healthy have behaved irresponsibly and should suffer the consequences of their bad decisions.  Well, this at least explains why you want people to lose their health insurance, but it has other problems.  In particular, it means encouraging people who are not young and healthy to engage in irresponsible behavior for which they, too, will eventually have to suffer consequences.  Encouraging other people to be irresponsible doesn't seem very responsible to me.  I suppose the suffer-the-consequences people would answer that they are all for young people buying health insurance, so long as it is not on the exchanges, but done in some other way that assures it does not subsidize anyone else.
For the most part, though, I think this is driven by blind partisanship more than anything else.

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