For years, even before Barack Obama was elected, one of the many complaints liberals (mostly) had about the current employer-based health insurance system was "job lock"—if you have insurance at your job, particularly if you or someone in your family has health issues, then you're going to be hesitant to leave that job. You won't start your own business, or join somebody else's struggling startup (unless they provide insurance), and this constrains people's opportunities and dampens the country's entrepreneurial spirit.
That this occurs is intuitively obvious—you probably know someone who has experienced it, or have experienced it yourself. And today there's an article in that pro-Democrat hippie rag The Wall Street Journal entitled "Will Health-Care Law Beget Entrepreneurs?" Amid the worrying about the implementation of Obamacare in January, and the quite reasonable concern that the news could be filled with stories of confusion, missteps, and dirtbags like that Papa John's guy cutting employees' hours rather than give them insurance, to avoid the horror of increasing the cost of a pizza by a dime, it's a reminder that there will probably be lots of stories like this one in the news too, stories about people whose lives have been changed for the better by the fact that Americans will have something they've never had before: health security.
When Wisconsin Congressman Paul Ryan and other hard-line conservatives talk about cutting the government’s budget, their primary rationale is that individuals can make better decisions with their own money than the government can. As Ryan himself said to an audience at Georgetown University, “We put our trust in people, not in government. Our budget incorporates subsidiarity by returning power to individuals, to families and to communities.” It sounds reasonable—of course we want individuals to have power, and of course we want communities to take care of their neediest members. And since conservatives have done a fine job of portraying the government as full of heartless, inept bureaucrats, allowing people to make their own decisions sounds better than the alternative.
When he began his still-brilliant show a few years ago, Stephen Colbert said, "Anyone can read the news to you. I promise to feel the news at you." And there's nobody who feels the news quite like Peggy Noonan, America's most unintentionally hilarious columnist. Pretty much every time she writes a column or goes on television, Noonan can be counted on to tell us about a feeling out there in the land. It's seldom a powerful feeling; instead, it's more often a stirring, an inchoate emotion still in the process of crystallizing. It might be a yearning, or an unease, or a doubt or a fear, but it lingers just out of our perception until Peggy Noonan comes along and perceives it for us.
Did you think the impact of yesterday's Supreme Court ruling was that millions of uninsured Americans will now be able to get health insurance, and after 2014 none of us will ever need to fear the words "pre-existing condition" again? Nay, good-hearted Americans:
In vowing this morning to do what the Supreme Court didn’t—repeal Obamacare—Mitt Romney trotted out all his arguments against the newly constitutionally sanctioned health-care law. Among them were these two points: First, that Obamacare would cause 20 million Americans to lose their health insurance, and second, that it would be a job-killer to boot.
Problem is, these two arguments directly contradict each other.
In tomorrow's New York Times, Annie Lowrey has an interesting story about a study researchers were able to do in Oregon when the state had to hold a lottery to give people Medicaid coverage, leading to the perfect conditions for a randomized field experiment on what effect obtaining insurance could have. The results were pretty encouraging:
In a continuing study, an all-star group of researchers following Ms. Parris and tens of thousands of other Oregonians has found that gaining insurance makes people healthier, happier and more financially stable...
Looking forward to the FreedomLibertyCare plan. (Flickr/Speaker John Boehner)
There seems to be a consensus building that the most likely outcome from the Supreme Court on the Affordable Care Act is that it will strike down the individual mandate but leave most of the law in place. Just how disruptive this will be to the near future of health care in America is open to debate (see Sarah Kliff for the optimistic take), but there's another question I'm wondering about: How are conservatives going to react?
An anti-Obamacare ad, in which a D-Day veteran explains how universal health insurance is as great a threat to our freedom as Nazism was.
When the Supreme Court issues its ruling on the constitutionality of the Affordable Care Act, we'll begin a new chapter in this saga, one that will probably (well, maybe) involve sorting through how the law's implementation will work once the individual mandate is struck down. But we've reached the point where there's no denying that the fight over public opinion has been lost, and that ground may never be regained no matter how hard the Obama administration or progressives might try.
Congressional Republicans discuss health care. (Flickr/nkenji)
The Supreme Court will rule on the constitutionality of the Affordable Care Act soon, and that has concentrated some Republicans' minds. It was all well and good to shout "repeal and replace!" when there wasn't really anything they could do about it, but if the Court actually strikes down some or all of the law, they'll be under greater pressure to put their money where their mouths are. The central quandary is this: if the law's least popular provision—the mandate for everyone to carry insurance—is struck down, that means the law's most popular provision—the requirement that insurance companies accept everyone, regardless of pre-existing conditions—has to go as well. Not only that, some other popular provisions, like the requirement that insurers allow young people up to age 26 to go on their parents' insurance, would disappear if the Court strikes down the whole law.
Should that happen, President Obama and other Democrats will immediately begin attacking Republicans for taking away these popular benefits. After all, the overturning of the ACA is a Republican project from start to finish, from the lawsuits brought by Republican attorneys general to the Republican judges on the Court who will undo it. So what do you do if you're a Republican member of Congress? Well, you start pretending that when you get around to that whole "replace" thing, you'll keep the stuff everybody likes.
People like me often complain about "he said/she said" reporting, which treats all claims by competing political actors as having equal validity, and doesn't bother to determine whether one side or the other might not be telling the truth. There are lots of reasons why that kind of reporting is harmful, but it's important to understand that it doesn't just keep people soaking in a lukewarm bath of ignorance, it can actively misinform them, leading them to believe things that are false.
Today's New York Times has a textbook example of what happens when political reporters can do when they refuse to adjudicate a factual dispute between candidates. In the story, Michael Barbaro doesn't just allow Mitt Romney to deceive, he actively abets that deception in the way he constructs his narrative. Here's the key excerpt:
Sometime soon—probably in three weeks or so—the Supreme Court is going to hand down its ruling on the Affordable Care Act. Given what happened at the oral arguments, there aren't too many people predicting that the ACA will be upheld, although that of course remains a possibility. Those oral arguments now seem like someone smacking us awake out of a dream in which we believed that the Republican-appointed justices might have something in mind other than the partisan and ideological advantage of their side. It was a weird dream, so weird that in the days before the arguments, some people seriously discussed the possibility that Antonin Scalia might be bound by the logic he had followed in previous cases involving the commerce clause and vote to uphold the law. What a joke.
Conservatives used to say that a conservative was a liberal who had been mugged. In other words, your abstract political ideology has to shift when it bumps up against unpleasant reality. Something similar can happen with politicians—not that they undergo wholesale ideological shifts, but many have some issue on which they have personal experience that leads them away from their ideology. For instance, Alan Simpson, a staunch conservative in almost every way, has advocated against harsh sentences for minors who commit crimes, because he himself grew beyond his run-ins with the law as a teenager.
As you've probably heard, Ann Romney suffers from multiple sclerosis. In a new video on the Romney campaign's web site, the Romneys talk about how they've dealt with the disease, and encourage people to donate to the National Multiple Sclerosis Society. Which is good, but when you run for president, your own personal life is necessarily political. It's important to be sensitive in how we talk about this, but Jonathan Cohn says exactly the right thing. It's terrific that Mitt Romney has been so devoted to his wife, "But if you have MS, or any other serious chronic illness, you need more than a devoted spouse. You need a way to pay your medical bills." For people with any chronic illness, paying those bills, and getting and keeping coverage in our brutal private insurance system, can be difficult and at times even impossible. Cohn goes on:
I've written many times, by way of explaining congressional Republicans' actions on the issue of health care, that it just isn't something that conservatives as a group care very much about. They have other interests, like taxes and the military, that they'd much rather spend their time on. This may strike some as unfair, but I think it's pretty clear from everything that's happened over the last couple of decades that it's true. There are a few conservative health wonks, but not nearly as many as there are on the liberal side. I can't think of any conservative journalists who are deeply conversant with the policy challenges and details of the health care system, while on the liberal side we have a number of such people, like Ezra Klein and Jonathan Cohn. Liberals have organizations dedicated to reforming the health system and achieving universal coverage; conservatives have organizations dedicated to stopping liberals from reforming the health system and achieving universal coverage. Other than an eternal desire to limit the ability of patients to sue for malpractice (which is as much about hamstringing trial lawyers, who donate a lot of money to Democrats, as it is about improving health care), Republicans only propose anything intended to improve the health care system when political events make it impossible for them to remain silent.
Which is why it's reasonable to be highly skeptical whenever congressional Republicans start talking about what they'd like to do on health care. That's the proper spirit to take the latest news on how conservatives are positioning themselves:
Once the law is fully implemented, health care exchanges will be the part of the Affordable Care Act we likely notice most. The exchanges were designed to turn health insurance into something approximating a real market—unlike the current system which creates a myriad of blocks that prevent the consumers from purchasing health insurance as they would any good, forcing families to either receive insurance through their employer, pay exorbitant costs for individual, or go without any coverage. The exchanges—along with subsidies for low and middle-income Americans—will ease that burden, allowing consumers to select a plan from a central hub without worrying about pre-existing conditions affecting their coverage.
Maybe Republicans aren't so opposed to health care reform after all. After grandstanding against the Affordable Care Act for the past few years, Republicans aren't ready to let the entire bill die should the Supreme Court overturn the law later this summer. Congressional Republicans are crafting a contingency plan to reinstate some of the popular elements of the bill in that scenario, according to Politico. It's a clear indication that the GOP has learned the same lesson as Democrats: while the all-encompassing idea of Obamacare may fair poorly in the polls, voters typically support individual elements of the bill.
Today, the members of the Supreme Court will meet in private to begin deciding the fate of the Affordable Care Act, and the millions of Americans whose lives and futures stand to be made more secure because of the ACA. It's entirely possible that Anthony Kennedy will discover some place in his heart where integrity and a respect for the true role of the Court are supposed to be and the Act will be upheld, but at the moment you won't find too many people willing to bet on it.
So I'd like to spend a few moments working through what might happen if the Court takes the middle course, which could be the most likely—striking down the individual mandate, but leaving the rest of the law intact—both in the short and long term.