As Jim explains at some length below, even the insurance companies that were the greatest boosters of the so-called Affordable Care Act are fleeing the exchanges or preparing to flee them; certain unkind rodential-nautical metaphors come to mind. USA Today has a very thorough report here.
Let’s take a second to remember how, exactly, this mess got sold to us: On the one hand, we got endless sob stories about the horrors of American health care circa 2008—“This telegenic child has a terrible disease and big mean meany health insurance companies won’t help,” “This telegenic single mom has a horrible ailment and she lost her insurance because of greed greed greed,” etc. The Republicans’ response was, roughly, “Harrumph,” or, if they were feeling loquacious, “We have the best health-care system in the world, harrumph, harrumph.”
Swayed by the sob stories, a substantial share of the American voters convinced themselves that nothing could be worse than what we had, and the Obama-Pelosi-Reid Axis of Mediocrity set about proving them wrong.
And here we are.
Reality isn’t optional: On the matter of UnitedHealth Group, USA Today writes: “The nation’s largest health insurer warned Thursday that it may pull out of the Obamacare exchanges after 2016 – forcing more than a half million people to find other coverage – after low enrollment and high usage cost the company millions of dollars.” Not only could that outcome have been foreseen, it was foreseen, predicted in these pages and among economically literate people of all sorts. People respond to incentives, and Obamacare creates exactly the sort of incentives that produce the outcomes that UnitedHealth cannot afford.
All of the political pressure is configured to make Obamacare more expensive and to do less to pay for it, thus Democrats, pushed by their union-boss patrons, are working feverishly to repeal the “Cadillac tax,” one of the main revenue instruments by which this mess was supposed to be funded. Who could have seen that coming? Everybody.
Conservatives are always at a bit of a disadvantage in the theater of mass democracy, because people en masse aren’t very bright or sophisticated, and they’re vulnerable to cheap, hysterical emotional appeals. (The phenomenon of “None of Us Is As Dumb As All of Us.”) Conservative policies require explaining to voters a little bit about supply and demand, incentives, complexity, market operations, etc. A sick child doesn’t need to be explained; everybody gets that. And from the Trumpkins to the idiot children at Princeton and Missouri reduced to screaming fits by the presence of thoughts they find uncomfortable, emotional incontinence is the order of the day.
The Founders understood this, which is why they so often expressed fearful reservations about democracy even as they set about creating the finest example of democratic-republican governance the world has ever seen. If you want to know why conservatives insist so energetically on limited government and constitutional process, take a gander at the hysterical idiot children at Princeton and ask yourself if you think that is a good model for addressing complex social problems.
The practical takeaway from the catastrophe that is Obamacare is that Republicans need to be on offense across the spectrum of policy disputes at all times. The conservative and libertarian think-tanks have a dozen or two good health-care reform proposals sitting in a drawer at any given time. Instead of fighting a war of containment against the collectivization of health care, the right move for Republicans in 2009 would have been to say: “Oh, you want health-care reform? We’ve got health-care reform! Here’s X, Y, and Z.” Republicans need to fill the vacuum instead of creating one. Obamacare is failing, and repealing it would be an excellent thing. But then: What? If the answer is “Harrumph!” again, Republicans are going to lose again. If you think the health-care mess can’t get worse, you don’t have much of an imagination.
It doesn’t have to be a big, sweeping proposal; in fact, Republicans should probably shy away from almost every proposal calling itself “comprehensive.” But with thousands of Americans losing their health insurance because of Obamacare’s failures, this would be an excellent time to, to take one obvious example, press forward with permitting the interstate sale of health insurance. Enabling that isn’t a small or simple thing, but it’s an important reform that shouldn’t be too hard to sell: “Unhappy with your health-insurance choices? How about 500 additional choices?” This also would be a good time to start eliminating some of the coverage mandates such as the ones that ensure that 65-year-old gay couples have adequate subsidies for birth-control pills.
Foreign policy and national security are dominating conservative thinking at the moment, which is proper given the situation with the Islamic State, the refugee question, etc. (It is also natural that this should dominate Republican presidential politics, given that natural security is an inherently federal function in which the president plays a large constitutional role.) But, given their commanding position in Congress and the states, Republicans should be rallying behind a Contract with America-style full-service domestic agenda. They won’t win on every issue, but they would keep the Left hopping, and that’s worth something, too.