Conservative wishful thinking on healthcare repeal

Right-wing analyst's "plan" for repealing the landmark law is a fantasy


Jonathan Bernstein
April 21, 2010 6:22PM (UTC)

Ramesh Ponnuru, in the National Review, argues for repealing healthcare reform. As Jonathan Chait points out, he doesn't really make a case that repeal is plausible; his strongest case in that there could be a pro-repeal majority in the House, and that by 2013 a Republican president could sign such a bill, but the best he has for the Senate is that Republicans could run against filibustering Democratic Senators. 

The problem with the piece is that, barring a real chance of repeal anytime soon, what's left is basically electoral advice to Republicans -- healthcare is a winner! -- but it can only do so by playing fast-and-loose with the evidence. Begin with the central paradox of healthcare polling, which is that the overall Democratic bill polled badly, while the individual benefits polled well.  Ponnuru says,

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Here is what can be said with confidence about the polling. First, most people do not have strong views about the details of health-care policy. The results of polling on such issues as the public option and the employer mandate have been highly dependent on the wording of the questions. Second, some elements of the plan poll well in general but others do not. The public does not, for example, seem to be fond either of the cuts to Medicare or the requirement that everyone buy insurance on pain of fine. Third, the popularity of some elements of the plan obviously does not stop majorities from disliking Obamacare as a whole.

That last sentence is tricky, no? One could just as easily say that the unpopularity of reform as a whole doesn't stop majorities from loving the details. When polling numbers are inconsistent like this it's tempting to believe that the public "really" supports your side of the question, but a more honest approach would admit that neither side can really claim clear public support. Of course, if you're trying to argue that your position is more popular, you may give in to that temptation -- but if you're advising candidates about what to do, it seems to me that you're going to get in big trouble if you give them candy-coated advice.

Generally, Ponnuru's interpretation continues to be radically partisan. Thus when seniors start getting rebate donut hole checks, somehow that's going to be a disaster for the Dems, because apparently those who get the checks won't much care while those who don't will be wildly jealous. This seems extraordinarily improbable to me; getting a check seems a lot more noticeable than not getting a check. Ponnuru is much taken with reported hiccups in the early stages of implementation, claiming that "events post-enactment have increased the public’s doubts about Obamacare." That doesn't seem to be the case in Pollster.com's tally of post-enactment polls, however, which is hardly surprising, because the stories Punnuru cites haven't been front-page news (except, perhaps, on those front pages which only those who oppose the bill anyway are reading). Ponnuru also expects tax credits for small business to backfire... one wonders whether he is as careful to imagine all the ways that Republican-backed tax cuts might not work.
Of course, as Chait points out, Republicans get into even more problems when they try to pair repeal with reform, claiming that they can achieve the popular things promised by the Democrats without using the supposedly heavy-handed big-government solutions included in the bill. The reason for that is simple: while the goal of the bill is certainly a solidly liberal goal, the means of getting there are not particularly heavy-handed.  Ponnuru gets tangled up in that in his discussion of preexisting conditions.  He expects the law's interim solution of high risk pools to be a failure:

It is not clear that Obamacare’s risk pools will be adequately funded or well crafted. They are likely to have many more applicants than openings.

And yet Ponnuru does acknowledge that high risk pools are in fact the Republican solution to pre-existing conditions, and he does not contest the idea that the government should find a way to deal with that problem (and, indeed, he deserves credit for saying that the individual mandate is a necessary part of the Democrats' preferred solution).  What I don't understand is how he thinks that problems with implementation in 2010-2012 will help the GOP's argument, since it will leave them attacking high risk pools -- which is their solution, and which the Democrats can point out will soon be phased out in favor of an outright ban on rejecting customers.  He may be right that ACA's interim high risk pools are inadequately funded, but does he really want to add "spend a lot more on these high risk pools that aren't working well" to "spend more on Medicare" in the GOP 2012 platform?

I have no better guess about where the polling is going than Ponnuru does (well, maybe a little better, since I can at least read actual polls instead of, as he apparently does, simply assuming that they must support whatever he wants them to support). But I've always said that the assumption that Democrats would benefit from passing healthcare reform, even if it was popular, is highly questionable. Taking basic healthcare reform -- an issue that has helped Democrats for years -- off the table, I've always thought, should hurt the Democrats... perhaps there could be (if it is popular) an initial bump, but after that everyone will just accept the new status quo, and argue about who can administer it best. And on that, Republicans could, if they play their cards right, compete on even terms. But repeal, it seems to me just puts the Republicans back on the losing side of the issue.

I guess a more basic point is that to the extent that the Obama bill is a "government takeover," what that can really mean (and be true) is that it is a claim of government's ultimate responsibility for making healthcare a basic right, and a responsibility for a system that functions well. The problem throughout the healthcare debate for conservatives is that they basically conceded that point; they really aren't wiling to take a strong laissez-faire position that the problems a market creates are not the government's business. Given that they therefore aren't arguing about philosophy -- and given that the Democrats chose a market-oriented approach to reform -- there's never been an honest, comfortable alternative for the GOP to support. Passage doesn't change that, but it does open a much better battle for them, if they shift ground from opposing reform to managing reform. As long as they don't make that shift, my guess is that they'll be playing on the Democrats' turf, and they'll continue to be hurt by healthcare.

Update: Ponnuru vs. Chait, round two. For what it's worth, I think Chait gets the best of this one too, especially on the key question of reconciliation -- there's no way, for example, that Ponnuru's one sentence repeal bill could get through under current reconciliation rules.  Also, neither of them mentions in either piece the budgetary effects of reform; GOP rhetoric notwithstanding,  repeal would blow a big hole in the budget, and it ain't gonna be fixed by substituting "adequately" funded high risk pools. Now, I'm fully expecting the GOP to pay little attention beyond lip service to the deficit should they have unified control of government in 2013 (which, by the way, I think is fairly unlikely, but it's Ponnuru's fantasy, not mine), but I'm not convinced that their first priority will be spending a lot more money on Medicare. 

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Jonathan Bernstein

Jonathan Bernstein writes at a Plain Blog About Politics. Follow him at @jbplainblog

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2010 Elections 2012 Elections Healthcare Reform

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