Maybe Just a Cigarette More

I am generally an optimistic man, and I remain as much about the future prospects of the American experiment, but the dark and idiot specter of Obamacare does sometimes give me pause. The Republican party’s persistent inability to scuttle this deeply stupid law really seems to confirm what we’ve more or less known all along: that Barack Obama and his congressional Democrats knew very well that repeal was very likely going to be politically impossible.

To be fair, American political lexicon tends to equate “politically impossible” with “literally impossible,” but that’s not really the case: what it actually means is that anyone who axes Obamacare is going to have to deal with a bunch of angry voters and a possibly terminal election cycle. If the GOP believed any of its eight-year-long bluster, it would do a clean repeal of this miserable law, start working on some decent deregulatory fixes to the American health care market, and let the chips fall where they may in November. But we’re not getting that, because of “political impossibility,” i.e. the threat that Republican senators might have to justify acting on the things they’ve been swearing by for nearly a decade.

At Slate, Jim Newell offers a compelling theory that Republicans “never really hated Obamacare:”

Despite the aura around it, Obamacare, in its individual market reforms, is essentially just the idea that sick people should be able to purchase quality insurance at roughly the same price as healthy people. All of the law’s regulations, carrots, and sticks—guaranteed issue, community rating, essential health benefits, the individual mandate, subsidies, single risk pools, etc.—were put in place to make such a market feasible. To “repeal Obamacare” is to segregate sick people from healthy people, so that the healthy are not subsidizing the sick.

It turns out, most people don’t really want to do this. Which is why, in each chamber, when the conservative bloc would put forth a version of an amendment that would truly “repeal Obamacare,” it was met with a revolt from the rest of the party.

This is not a crazy hypothesis—the supposition, I mean, that Republicans “don’t really want to” repeal the Affordable Care Act. Surely there are a few among the more ideological wings of the party that want to see it go. But when you can’t rally enough members of the nominally conservative party to repeal the one law they all allegedly hate—and when you can’t even get enough members to vote to kinda-sorta-half repeal certain parts of the law for just a few years, as the “skinny repeal” promised to do—then surely it is worth asking: what do you people even believe in?

The idea that “sick people should be able to purchase quality insurance at roughly the same price as healthy people” is, of course, both economically illiterate and commercially ignorant: insurance does not, and cannot, and should not, work this way. The reason that sick people have generally paid more for health insurance is that sick people cost more to insure. The parameters of our healthcare debate have largely excluded this objectively factual characteristic of the health insurance market because we are under the impression that, if we simply say “Sick people shouldn’t pay more for insurance!”, then we can magically will it into reality. But this isn’t the case. A central platform of progressive government policy over the past dozen decades or so has been that you can wish away the hard realities of the medical economy without incurring some kind of negative externality in the process. But you can’t.

It should not be hard for a genuinely conservative party to repudiate such illogical ideology and substitute for it a more grown-up and honest look at the way the world works: yes, sick people are going to have to pay more for health insurance and health care, but if we focus on genuine reforms to bring down the price of both, then it won’t seem as outrageous as the Left has made it out to be. We have been denied such a discussion, however, largely because Democrats have re-defined the acceptable criteria of our healthcare debate: instead of one side proposing the idiot insurance regulations of Obamacare and the other side arguing for a more fact-based approach to health care policy, we have both sides largely arguing for the same thing: full-on Obamacare on the one hand, gradualist ACA-lite six-year-temporary-repeal Obamacare on the other.

Republicans, who might have spent nearly the past decade exposing the fundamental stupidity of Democrat health economics, have instead evidently accepted the premise of those economics, framing their legislative ambitions strictly within the Overton window established by Barack Obama in 2010. In a sense, then, I don’t blame them for failing to repeal the Affordable Care Act: if you’ve more or less decided that it’s a necessary part of federal policy, then why risk your congressional seat over it? The unpleasant side effects of Obamacare—the higher premiums, the useless coverage, the restricted market, the grossly expensive and unworkable health care economy generally—are not really their concern. It falls to us—the people they represent—to deal with it. And so we will; apparently there is no avoiding it.


  1. J Jones

    Most people obtain health insurance when they are well. I paid into health insurance for 39 years when I was employed. Now, pay for Medicare and supplemental health. Am grateful to have it, especially in case of a catastrophic illness. As a middle class, healthy retiree, everything could be lost without health insurance, in the face of a major health issue.

  2. Mrs C

    Most people now expect insurance companies to pay for every doctor’s visit. We used to pay out-of-pocket for visits to primary care or specialists for check-ups. Now we want it all covered and for less. We cannot have it both ways. Stop the subsidies to doctors and insurance companies and allow coverage choice and let the medical professionals and insurers compete beyond state lines. Politically popular or not, if controlling Republicans do nothing, they’ll lose supporters for not keeping their promise to repeal and replace Obamacare.

    • Daniel Payne

      I know of primary care physicians who have abjured all insurance and instead just do out-of-pocket. They’re far, FAR less expensive than a “normal” doctor’s office.