Matt Miller - The Archives

Republican fallacies on Obamacare: the greatist hits
The Washington Post, December 4, 2013

Before the holiday spirit makes Republican-bashing a little unseemly, it's time to get in a last ornery blast at the party's Obamacare stance. Republicans have enjoyed themselves immensely during the Affordable Care Act's bungled rollout, but most of the claims they're making are preposterous and phony. Since anyone able to take a longer view knows we'll one day be well past Obamacare's self-inflicted wounds, I'd like as a public service to catalog the GOP's shabbiest arguments, so we'll all have a handy reference once the worm fully turns.

The selective "humanitarian crisis." Conservatives have warned of the "humanitarian disaster" that will ensue if several million people with cancelled policies are unable to secure new coverage before January 1. But this theoretical woe (which will almost certainly be avoided thanks to Web site fixes and policy extensions) pales next to the much larger humanitarian disaster of America's nearly 50 million uninsured—a crisis that's persisted for decades without conservatives caring a whit. I can't be the only one who finds the right's sudden concern for a small subset of the uninsured a bit rich.

The bogus oppression of the young and healthy. Another confused conservative trope bemoans the enslavement of younger or healthier Americans, who've supposedly been conscripted to subsidize their older, sicker countrymen. "Liberals justify these coercive cross-subsidies as necessary to finance coverage for the uninsured and those with pre-existing conditions," the Wall Street Journal editorialized last Saturday. "But government usually helps the less fortunate honestly by raising taxes to fund programs." Actually, the Journal has the American way of health subsidy exactly wrong. Most people aged 19 to 34 who have health coverage get it from their employer. And, as I've noted before, at nearly every firm, young people pay the same premiums as employees who are older and get more expensively sick. In other words, Obama's scheme to rob Peter to fund health care for Paul already exists, at vastly larger scale, in corporate America. And while Obamacare is only hoping to sign up 2 million or so young people, 20 million Americans aged 19 to 34 get their coverage on the job. Where's the Wall Street Journal's rant against corporate America's "coercive cross-subsidies"? And while we're at it, when will we stop making all those people whose houses don't burn down subsidize those whose do?

The "men and 55 year old women don't need maternity care" fallacy. Well, yes, and people whose genes don't predispose them to cancer (which tests will reveal soon enough) don't need cancer coverage. As Bob Kocher, a doctor and former senior Obama health care advisor, explained, if one of our goals is to not charge women higher premiums than men, all plans have to cover maternity. Among younger women, moreover, maternity is the biggest driver of costs—so if you allow optional coverage, the plans young people buy would be super-expensive. "For insurance to work, you can't allow people to opt into benefits like maternity right before they get pregnant," Kocher adds. "When spread across the population, it's not expensive." Sounds like Insurance 101. Which in the social insurance context, conservatives can't abide.

Insurance "bailout" baloney. Sen. Marco Rubio talks opportunistically (but I repeat myself) of Obama's pledge to "bail out" health plans if the folks they sign up end up being unduly costly to treat. Once again, conservatives eat their own. Such "risk adjustment"—after-the-fact payments to reflect the actual vs. expected risk experience of health plans—has been a sensible staple of conservative insurance market reforms since George H.W. Bush proposed it in 1992. Little known but true: Before Romneycare begat Obamacare, Bushcare begat Romneycare. Rubio was only 21 then. He must not know. Or care.

The "Obama is taking over one-sixth of the economy" ruse. In the Fox News cocoon, this truth is self-evident. But it makes as much sense as crying that Ben Bernanke is "remaking 6/6ths of the economy" every time the Fed touches interest rates. The fact that health-care spending is 18 percent of GDP doesn't mean Obama is "remaking" or "taking over" anything. He's tweaking a dysfunctional corner of the market where 5 percent of us get our health coverage. He's also testing ideas that health gurus in both parties have long suggested might help reign in future costs.

Worse than these GOP fallacies is the party's smug sanctimony. It's as if conservatives have decided to parody the moral preening they loathe in liberals, except that the right is serious. As one pundit lectured, "the administration didn't care enough to make sure the people of their country were protected. In the middle of a second age of anxiety they decided to make America more anxious."

Yes, the rollout was botched. But what is this person talking about? Finally assuring that illness in the United States can't be the cause of financial ruin is the very essence of "protection." How galling that conservatives can make such hollow charges while putting forward no plan of their own to "protect" anyone from anything!

Or take the pundit who wrote that "extending enrollment periods does nothing but provide Americans more time to contemplate their miserable choices." Only someone with no empathy—someone who has never tried and failed to get coverage in the individual market—could possibly say such a thing.

I've spent a lot of time over the years arguing that we can solve big problems such as providing insurance coverage in ways that honor both liberal and conservative values. It's entirely doable—John Rawls and Milton Friedman can be reconciled, trust me. Apart from being sound policy, I've assumed such approaches would also be necessary, because with power closely divided in the United States, we'd need to strike big cross-party deals to make progress. The breathtaking intellectual and moral dishonesty of those driving the Obamacare debate in the GOP today makes me feel foolish for having tried.