Running the Gauntlet

After cataloging the gauntlet that the PPACA must run over the next two years, Shikha Dalmia remarks:

No doubt Democrats are going to berate Republicans as obstructionists. President Obama lectured Republicans to “stop hating all the time” after they voted this week to challenge the legality of his executive actions in court.

But the reality is that unless public opinion swings dramatically in Obamacare’s favor, Republicans have no skin in the game and no reason to cooperate.

All of this means that Halbig was just the beginning. For the foreseeable future, the country will remain embroiled in Obamacare battles—instead of actually fixing the myriad problems with American health care.

What I think that many supporters of the PPACA miss is that the unpopularity of the PPACA was designed in from the start. The number of people that it hurts was designed to outnumber of people it helps. Presumably, the idea was that it would hurt the people it hurt only a little and it would help the people it helped a lot. I don’t think that’s quite worked out as expected. For whatever reason the president and Congressional leaders thought that the law would be more popular than it has turned out to be and that its popularity would grow in the near term.

That hasn’t happened and if anything it has become less popular over time. The attitude now seems to be that public opinion is bound to turn around eventually. Un bel di.

13 comments… add one
  • PD Shaw

    “For whatever reason the president and Congressional leaders thought that the law would be more popular than it has turned out to be and that its popularity would grow in the near term.”

    Could be. Or they could have been obsessed with tactics and minutue that they lost track of the big picture. Or they were afraid of internal backlash if they didn’t seize this opportunity and acted without regard to the consequence, perhaps out of principle even.

    On that last possibility, I think I commented at the time that it made more political sense toward the end for the Democrats to lose this battle and keep the issue to beat Republicans over the head with. Instead, we have probable Republican majorities in the House for ten years, and a law of perhaps half-measures, that puts Democrats on the defensive for anything wrong with the healthcare system.

  • jan

    The PPACA was designed in an incremental but deceptive manner. The first couple of years rendered benign “goodies” — such as young people staying on their parent’s insurance until 26, and the acceptance of pre-existing condition. But, then came the one-sided tinkering with the law that occurred when it was politically necessary for the democrats to defer it’s punitive effects until after an upcoming election. This happened in the 2012 general, when extensive regulations, haphazard registration, and negative implications of the PPACA were kept under wraps until 2013. The same is occurring for the 2014 midterms, when employer mandates become realized, along with another stream of policy renewal increases for people in 2015.

    It all seems devious to me. But proponents of the law continue to focus on the side of the balance sheet extolling only it’s virtues. Any downside is condemned and seen as just politically motivated.

  • PD Shaw

    Something I have thinking about is the idea of legislative supremacy, the idea that the legislature cannot bind itself. If the legislature could bind itself, it cannot be supreme. The past cannot imprison the present cannot chain the future. But it does in areas of pensions and discrimination and environmental problems — we bear the debts of the past without many of their assets.

    The ACA does not bind this Congress, but for Congress to act it must pass law.

    The ACA does not bind Congress, but it does bind this and future Presidents.

    This seems to be the central paradox. Congress will not support the law with the types of adjustments that are necessary for its continuation, nor is it compelled to in a democracy; the President won’t support portions of the law in order to ensure its continuation; and the law continues as the walking dead.

  • TastyBits


    I predicted that each postponement past the next election would lead to a postponement past the following election for the same reason, and so it has been.

    After the 2014 elections, the reality of 2016 is going to sink in. If a Republican wins the presidency, the postponements will be permanent.

    Expect it to get really strange, really fast.

  • Jimbino

    Insurance of any kind hurts people on the average, since the return on the premium dollar is less, often much less, than a dollar. Insurance is a negative-sum game.

    That said, one is advised to throw down the gauntlet and run the gantlet.

  • steve

    It was designed to be program that was actually paid for. In that sense, it will hurt more people than it helps. The same is true of most govt programs. It will remain unpopular with the same folks who hate Medicaid. Meh. You may be right that if the GOP sweeps in 2016 that it will die a slow death. However, I think if it does, the GOP will be pushed to provide an alternative. Will be a lot like the dog that finally catches the car.


  • mike shupp

    Hmmm… The Republcans — some of them — have been trying to get rid of that awful useless Social Security program for going on 80 years now. They’ve promised to eliminate the socialistic Medicare program for just about 50 years. So of course, they’re pledged to save us from the horrors of Obamacare.

    Third time’s the charm, eh?

  • michael reynolds

    The number of people that it hurts was designed to outnumber of people it helps.

    That statement is nonsense. You’re starting to sound like Ice.

  • Your remark reflects a lack of understanding of the mechanics of the plan. The plan is designed to be self-funding. That means that for solvency it depends on the majority of those in the plan paying more than they would otherwise so that the balance can pay less. That is inherent in any self-funding plan with guaranteed issue and community rating.

    As it looks right now the plan will not be self-funding. IMO that should never have been an expectation. The Democrats were on the horns of a dilemma. They wanted a plan but there were members of their caucus who had publicly stated that they would never approve any plan that was not self-funding. They settled on the present scheme and, as I wrote in the post, weak popular support was “baked-in” to the design.

  • steve

    Of course, your comment ignores how insurance works. It hurts most people and helps a few. However, the hurt is relatively small for most and it avoids a much bigger hurt. To which you might counter that even those who already had insurance are going to pay a bit more. But, people who have been losing their insurance because they lost their job, or for other reasons, were finding it harder to obtain insurance. The ACA pretty much guarantees that you can obtain insurance at an affordable rate (except in red states). We have yet to see what it will do to overall costs.


  • It hurts most people and helps a few.

    And that’s exactly what I wrote.

  • CStanley

    Honesty about the hurt that was going to come in higher premiums and inability to “keep your current plan” might have helped. It is the bald faced lying that galls me.

  • Andy

    “It hurts most people and helps a few.”

    True, but the PPACA wasn’t sold that way and I think a lot of the law’s unpopularity has to do with the failure to meet the expectations that proponents advertised.

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