Now I See the Problem

(From National Journal/United Technologies poll)

I have long felt that the opposition to Obamacare was essentially a partisan affair, with some Democrats and many Independents affected by the GOP anti-ACA disinformation campaign. The above chart, taken from a newly released National Journal/United Technologies poll, points out another fundamental issue that I had not taken seriously enough: the perception of the program as "helping the poor and the uninsured, but not everyone, and (certainly) not me". In other words, Obamacare represents a redistributive program, moving resources from the wealthy and the middle class to the poor. The extent to which this view is held by Democrats, Independents, and key parts of Obama's coalition (millenials, college-educated women, though not minorities) had escaped me, and I am enormously glad to have found this research, giving me more information, and (I believe) a clearer perspective. In short, I think I now see the problem.

America doesn't seem to favor redistribution, as much as it did in the 60s'. This is not only an anti-big Government response. It springs from a feeling of national scarcity, even decline, that we no longer have the abundance, and therefore the policy options that we used to have. What is given to one group of people is not available to others. Competition for resources becomes zero sum: win-lose. If you win, I lose; and vice versa.

Lots of things surely contribute to this attitude: the Conservative resurgence, beginning with Reagan; the Great Financial Crisis, and the apocalyptic cries of the GOP (and many others) that the country is broke, and debt/deficit disaster is just around the corner. I'll actually include the post-9/11 Bush/GOP reaction, telling the American people to be afraid, to be very afraid. We have been living in fear for much of the last 12 years. The GFC just shifted the focus from terrorism to our country's supposed financial fragility.

This is mostly nonsense; but though my training teaches me to notice my perspective - my lenses - and not to assume others look at the world from the same viewpoint, I missed this. I am, quite simply, an abundance thinker. Most others are not. So I missed.

So what is the significance of this? Even with a working website, even with millions enrolled. even with 2015 premium increases turning out to be modest, many Americans will be waiting for the other shoe to drop, revealing what bad thing will happen to me, because the poor and the uninsured are benefitting.  Broad acceptance will come slowly. It may take one or two years before people become broadly convinced that their world won't fall apart, just because the uninsured and the poor now have access to healthcare insurance. I could, therefore, be wrong that Obamacare will be a strong pro-Democratic argument in the 2014 midterms. I'm no longer sure of that, but I still see it as real possibility.

What can Obama and his allies do?

•  First, get the program working as intended. This means a working website; alternative methods of signing up through insurance companies; and strong enrollment.
• Second, consider supporting the Landrieu bill in the Senate, guaranteeing a renewal option to people with cancelled policies. Insurers will say this will unbalance the risk pool, but it's probably worth the risk because the "identified victims" will be removed.
• Point out repeatedly that what the ACA is doing in the individual market is moving it to be like the best employer-based plans, instead of the one by one, individual underwriting structure of the old non group market. "We want individuals outside of companies to have the same benefits folks at work have - everyone is in the same large pool; and everyone benefits." Also point out that the evidence is overwhelming that young, healthy individuals, when offered this option at work, most sign up for the insurance.
• Conservatives are pre-announcing doom on three subjects: what employers will do when the Employer Mandate kicks in on June 1; what will happen when 2015 premiums are announced; and how many people will lose access to their doctor or their hospital.  I don't think any of these will be real problems, but the Blue Team needs to be ready.
• Finally, it is time to make the case about the lowering of the inflation rate for healthcare costs. This is something that directly benefits everyone, and can easily be broken down to an average benefit per family, like the troubled $2,500 per family premium decrease the President promised. For example, if you compare the Medicare estimates prepared by the CBO in 2010, just before the ACA was passed, to the most recent 10 year estimates, there is a total reduction in projected expenditures of $1.026 trillion, or $8922 per household. Medicare is 21% of National Health Expenditures, so the overall savings per household would be much greater. Obviously these costs are not incurred on a per household basis, so individuals probably won't notice. But surely there has been a slowing of insurance premiums based on the cost curve bending down. The story needs to be told that the ACA benefits everyone, not just the uninsured, or the poor.

The healthcare cost slowdown is real. And this benefits everyone, giving a strong counter to the current story from the Right that because the poor and the uninsured are gaining, you (Mr. and Mrs. Middle Class) must be losing.

I am convinced the ACA is here to stay. I'm just not sure how quickly folks will appreciate that there is significant benefit for everyone. If the message gets out by summer, there is still a chance for a House turnover.

And maybe the GOP will treat us to another Shutdown! That would help a lot!