There is a great problem with Obamacare. It is needs based and not universal. No wonder a great many people dislike and resent it, including people who benefit from it.
There is a great divide between kinds of public benefits: the ones that go to other people versus the ones that go to oneself and ones family.
A problem for Obamacare is that most Americans, most of the time, don't need it and don't get it, but they pay for it. Most Americans, most of the time, have access to health care through their employer or somewhere else. Virtually everyone over 65 is eligible for Medicare, Veterans get the VA, people employed at a "job with benefits" have health insurance. People who have health insurance through age or military service or employment consider that benefit earned.
Obamacare is needs based. People who pay taxes and have earned their health care are paying for people who earn less, pay less in taxes, and get the ACA because they need it. It puts a huge divide into the public attitude toward it. I contrast this with Social Security, in which the benefits are skewed toward the poor (something prosperous people may not realize), but in which everyone pays the tax and gets a benefit generally based on the tax they paid.
Notice what we do not see: There is no populist groundswell of opposition to the government socialist pension program of Social Security.
Democrats who propose applying the Social Security tax on the full income of high paid employees, rather than capping it as it is currently done, while maintaining the cap on benefits, are taking a huge risk to the system. They will have turned Social Security into a needs based entitlement, in which people are paying for the benefits of others poorer and different from themselves. (Not capping the tax or benefits would be worse. If Bill Gates got a million dollars a month in Social Security benefits--even if he paid in fair and square and is entitled to them based on the tax he paid, people would howl.) The current system is well designed to provide near universal buy-in.
Food Stamps and Obamacare are needs-based. Note the language of derision by Newt Gingrich, calling Barrack Obama "the Food Stamp president." It was an insult.
Thad Guyer observes the ACA is likely to survive and settle into the general pattern of bipartisan entitlement muddle, just another complicated and unexceptional needs based benefit along with Medicaid, Food Stamps, Disability payments, fee-waived benefits, subsidized housing, etc. It will be generally disliked and unpopular, right along with other permanent fixtures of American life.
He predicts it will endure and become institutionalized, which Democrats will consider progress toward a more fair and just society. Simultaneously, it will become one more bureaucratic irritation and whipping boy for people who resent paying taxes to support other, less fortunate, less healthy, less provident people, an entitlement.
There is, in fact, another path for Democrats although there may not yet be a political consensus to allow it: make healthcare an earned benefit for everyone in a single payer system providing baseline service. People might pay for healthcare the same way they pay into Social Security: everyone pays, everyone gets. People with healthcare benefits are accustomed to paying for them, as part of a pay package with more or less visible employee direct contribution. Employers know full well that healthcare is not "free." It is an expense they pay for, and they would welcome it being more transparent. They pay for something they do not get "credit" for in the employee mind. It is entirely likely that Democrats can get employer buy-in. It would be the "pro-jobs" position, de-coupling health care from employers.
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| CNBC article. Click here. |
"Medicare" generally has credibility. My experience with Medicare recipients is that they are generally very pleased with the program. Those same people are generally suspicious of "government." From a message point of view, Democrats can call it "Medicare for all." Republicans will condemn it as "government health care."
We are paying for health care one way or the other. What is up for discussion is we pay for it and whether we are paying for our own heath care, or whether we are paying for someone else's health care. In the long run the only political stable equilibrium is for people to believe they are paying for their own.
Guest Comment by Thad Guyer:
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| Thad Guyer |
Healthcare Transitions from “The” Issue to a “Whatever” Issue
It’s likely that healthcare will remain a headline, certainly an inside the beltway resentment, but not a determinative issue in the 2018 midterms or 2020 general election. By now it’s clear to the electorate that there is, in fact, involuntary bipartisan resignation that Obamacare is a mess, it has to be fixed, but that’s as good as the Congressional reality will ever get. Voters know regardless of how they vote, Obamacare is going to slog on, and both parties will continue their feckless partisan rhetoric. This is not the stuff of an election-changing issue. It is, well, whatever.
Like any entitlement program, Obamacare will will no longer pack an ideological punch, like when it was enacted in 2010 during a fierce partisan civil war, and thereafter with “full repeal” fervor. But the apparent death of repeal will have resulted in the program's last gasps of ideological energy. Soon it will just another entitlement issue, like welfare, food stamps, public housing and Medicare, giant programs that nobody can do anything about except add or subtract around the edges. In election after election, these entitlement programs generate dogmatic interest only in the aggregate, under pitches of “entitlement reform”, slogans like “workfare not welfare” (Bill Clinton), and “slow the rate of entitlement growth” (Bush). Not one of these programs standing alone has ever been politically energizing for either party, not even Medicare despite bipartisan predictions of imminent collapse and calamity for the past two decades. This is the fate of every entitlement program. Broken, wasteful, inefficient, underfunded, inadequate, voters collectively yawn “whatever”. Healthcare will now join this boring aggregate of entitlement programs.
It's not plausible that Trump can “lose” the healthcare “issue”. Nor is it plausible that Democrats can “win” it. Neither political party will see its electoral fate dispositively strengthened or weakened by promises to expand, cutback, or leave Obamacare alone. Ironically, we’ve achieved that elusive unity, a bipartisan consensus, that the program with its myriad problems, is here to stay. Voters accept that neither party can do anything other than patch it up. Yes, headlines will erupt periodically with Obamacare horror stories about 50% premium increases, counties with no insurance providers, inadequate Medicaid funding levels, disputed anecdotes that some children and old people died. To all this, voters will say "how sad", then heave a big sigh of "whatever". America does not weep long for its poor.
Trump will be blamed, Democrats and Republicans will be blamed, and Congressional candidates will promise fixes and reforms. But there will be no energizing ideology in it, no bonanzas of televised crowds or surges in voter turnout-- for either party. Ideology will one day return to our healthcare debate when Democrats feel enough political safety to go all-in on single payer, but it’s hard seeing that happening before 2024. Single payer is just too scary. Baby Charlie Gard’s death in the UK, and the hopes of his parents snatched away by healthcare bureaucrats, will long be remembered and surely resurrected. Death panels are a reality.
In the meantime, America has got a growing list of toxic and polarizing ideological issues locked and loaded for 2018 and 2020, fierce partisan issues over immigration, law and order, and defense spending that motivate voter turnout. But healthcare is not likely going to be one of them again until 2024.
Like any entitlement program, Obamacare will will no longer pack an ideological punch, like when it was enacted in 2010 during a fierce partisan civil war, and thereafter with “full repeal” fervor. But the apparent death of repeal will have resulted in the program's last gasps of ideological energy. Soon it will just another entitlement issue, like welfare, food stamps, public housing and Medicare, giant programs that nobody can do anything about except add or subtract around the edges. In election after election, these entitlement programs generate dogmatic interest only in the aggregate, under pitches of “entitlement reform”, slogans like “workfare not welfare” (Bill Clinton), and “slow the rate of entitlement growth” (Bush). Not one of these programs standing alone has ever been politically energizing for either party, not even Medicare despite bipartisan predictions of imminent collapse and calamity for the past two decades. This is the fate of every entitlement program. Broken, wasteful, inefficient, underfunded, inadequate, voters collectively yawn “whatever”. Healthcare will now join this boring aggregate of entitlement programs.
It's not plausible that Trump can “lose” the healthcare “issue”. Nor is it plausible that Democrats can “win” it. Neither political party will see its electoral fate dispositively strengthened or weakened by promises to expand, cutback, or leave Obamacare alone. Ironically, we’ve achieved that elusive unity, a bipartisan consensus, that the program with its myriad problems, is here to stay. Voters accept that neither party can do anything other than patch it up. Yes, headlines will erupt periodically with Obamacare horror stories about 50% premium increases, counties with no insurance providers, inadequate Medicaid funding levels, disputed anecdotes that some children and old people died. To all this, voters will say "how sad", then heave a big sigh of "whatever". America does not weep long for its poor.
Trump will be blamed, Democrats and Republicans will be blamed, and Congressional candidates will promise fixes and reforms. But there will be no energizing ideology in it, no bonanzas of televised crowds or surges in voter turnout-- for either party. Ideology will one day return to our healthcare debate when Democrats feel enough political safety to go all-in on single payer, but it’s hard seeing that happening before 2024. Single payer is just too scary. Baby Charlie Gard’s death in the UK, and the hopes of his parents snatched away by healthcare bureaucrats, will long be remembered and surely resurrected. Death panels are a reality.
In the meantime, America has got a growing list of toxic and polarizing ideological issues locked and loaded for 2018 and 2020, fierce partisan issues over immigration, law and order, and defense spending that motivate voter turnout. But healthcare is not likely going to be one of them again until 2024.
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