Why Obamacare’s “Good News” Is Good For Conservatives (And America)

News this week that Obamacare had over seven million sign-ups will, I think, prove to be the public relations high point for Obamacare. The actual numbers who pay for insurance will come in lower, which means that higher premiums will soon kick in. That doesn’t mean Obamacare is going to go away. As Ramesh Ponnuru and Ross Douthat point out, Obamacare, for all its flaws, has permanently changed the politics of health care in this country. This week marks a moment when the broad right can absorb the lesson that, even if Obamacare is somehow undone, we are not going back to the pre-Obamacare status quo. If the right can come to terms with this reality, then this will have been a better week for conservatives than it was for Obamacare.

Maybe the most important thing to understand about the broad center-right’s (to include the right-leaning populist media and their audience) approach to health care policy was the dominance of status quo bias.  Even before Obamacare, some intellectuals and politicians proposed substantive health care reforms but most right-leaning voters and media personalities didn’t want to hear much about it. The framing on the health care issue was defensive. It was the greatest health care system in the world versus socialized medicine and as soon as socialized medicine was defeated it was time to talk about something else.  Anything else.

After the passage of Obamacare, this bias took the form of trying to return health care policy to the day before Obamacare was passed. Conservative intellectuals like James Capretta proposed replacements to Obamacare that would have had comparable or greater expansion of insurance coverage, but the political energy was much more on the side of repeal than replace. 

This was especially true in the 2008 2012 Republican nomination race.  Romney was compromised as a critic of Obamacare.  Many of the candidates who tried to market themselves as Tea Party favorites focused their energy on trying to perform hostility to Obamacare. The result was that they sometimes sounded less like politicians discussing a major issue and more like pro wrestlers issuing threats to their opponents in tonight’s main event. Watcha gonna do little Obamacare, when Gingrichmania runs wild on you?  I filed the first bill to repeal Obamacare and that’s the bottom line cause Stone Cold Bachmann said so.     

The 2008 2012 Republican presidential candidates might not have been as public spirited as we might like (with the notable exceptions of Rick Santorum and —by his own lights—Ron Paul), but they weren’t stupid. They knew that any replacement for Obamacare was going to inevitably produce winners and losers—including some angry interest groups. They knew that any particular reform would initially enjoy narrower support on the right than simple repeal. Building support for any particular reform would have been both risky and been expensive in terms of time spent studying the issue, familiarizing the public with the policy and defending the reform from attacks. Focusing on repeal was the path of least resistance.

It is different now. Whether the number of policies through the exchanges is seven million or five million, that is still a lot of people. Regardless of whether the people on the exchanges had health insurance before Obamacare, they are getting insurance through the exchanges now. They are a constituency and so are the people who care for them. Any repeal of Obamacare has to take their interests into account. Ted Cruz worried that when Americans got the “sugar” of the Obamacare subsidies, then Obamacare would become politically invincible. That wasn’t quite right. The expansion of coverage made returning to the pre-Obamacare status quo much less likely (and it was never likely), but it hardly closed the door on the kind of Obamacare replacement outlined by James Capretta. 

In the short-term a Republican politics based on replacement rather than mere repeal will be more internally divisive. That’s a good thing. Candidates will offer competing plans for keeping the coverage expansion at a lower cost to the taxpayer and with a greater role for competition among health care providers. The candidates who offer those plans will take fire from the media and each other. This is also a good thing. This is how we will get a conservative health care reform strategy that stands up as both good policy and prudent politics. By ending the dream that we can go back to the pre-Obamacare status quo, the events of this week will make it easier to craft a set of policies that will rid us of Obamacare.