Why the Fight over Obamacare May Never End

Since the Affordable Care Act was passed in early 2010, I've held more than one opinion on just how the American public will feel about it as time goes by. Initially, perhaps influenced by the momentousness of the Act's passage, I wrote that once it was implemented, it would be much harder for Republicans to attack. They would no longer be able to frighten people with phantoms of death panels, and instead would have to talk about reality. Since people would have their own experience with the law to judge from as opposed to some hypothetical future, the attacks would lose their potency, Republicans would back off, and the law would rise or fall in public esteem on its own merits.

Then I began to have second thoughts. One of the biggest problems, which I wrote about a few months later, is that Obamacare isn't a single program like Medicare that people can come to love. It's a whole bunch of pilot programs and new regulations, many of which involve private insurance or existing programs like Medicare and Medicaid, and when people are affected by those changes they won't necessarily see them as being part of Obamacare. For instance, beginning in January, insurance companies will no longer be able to deny you coverage based on pre-existing conditions. But to most people, interacting as they will be with private companies, it will look like Aetna or Blue Cross or whoever just got more humane, and they may not even know that the government made them do it. Even the exchanges, if they work well, will just be the place where you go to shop for private insurance. Your relationship with the insurer you choose will certainly be affected deeply by the ACA's regulations, but most people still won't understand exactly how.

Among the consequences are that Republicans will be absolutely free to continue to blame every problem anyone has with the health care system on Obamacare, without concern of producing a backlash from the law's supporters. Compare that to how they talk about Medicare, a program they've hated since the moment it was proposed. Because they know how much seniors love their Medicare, they have to pretend they would never harm a hair on the program's lil' ole head. Medicare cuts? Heaven forfend! We merely want to strengthen the program! Turning it into a voucher? Not us! We merely advocate premium support. It's supportive!

That ridiculous kabuki Republicans are forced into is what protects Medicare from the shivs they'd love to jam into its hide. But nobody is going to shout, "Take your hands off my Obamacare!" because Obamacare isn't going to be perceived as a thing you have. It's just a bunch of rules governing how other things run.

Republicans were no doubt overjoyed to see the latest Kaiser Family Foundation poll showing 19 percent of Americans believe that Obamacare has already been repealed, and another 23 percent don't know whether it's the law of the land or not. Most Americans have next to no idea what it does and how it might help them. Some commentators see that and blame the administration for not spending enough time communicating the law's benefits, which is like saying to a baseball player that the reason he's only hitting .250 is that he hasn't bothered to go the batter's box and attempt to hit the ball with his bat. They've spent untold energy and time communicating the program's benefits; I haven't bothered to count because I want to retain my sanity, but I'll bet that if you did you'd find that the president has given a couple hundred speeches, interviews, and statements about Obamacare.

The problem isn't that they haven't tried, it's that given the complex nature of the law, getting a largely inattentive and (let's be honest) ignorant citizenry to understand it is a very difficult task even for people who are good at that sort of thing, just like hitting 99-mph fastballs. Might it have been easier if the law were designed differently? Absolutely. If it were a single-payer plan, everyone would understand it. But instead, it's an extremely complex set of regulations, every one included to address a particular problem or woo a particular interest group or placate a particular ornery senator. That complexity was dictated by both the existing complexity of our health care system and political reality as the administration and congressional Democrats understood it at the time (accurately or not).

That isn't to say that Obamacare's image can't improve as we go through implementation in the beginning of next year. If you want a less gloomy view than mine, you can read Jonathan Cohn (here and here), who details some of the reasons to be optimistic about the early stages of Obamacare's implementation. It's entirely possible that if things go reasonably smoothly, people will say, "Gee, this isn't nearly as bad as Republicans said it would be." Implementation will get a lot of press coverage, and I'm sure many news organizations will do their best to help their audiences understand how the law will affect them. That will increase what people know, and also give the law's advocates another opportunity to make their case that it's a good thing. But even so, there'll be little reason for Republicans to let up on their attacks on the law. They may not be able to scream about death panels anymore, but they'll certainly blame every insurance company misdeed, rate increase, or anything else you might not like on Obamacare. That means that public opinion on it is likely to be divided for the foreseeable future, and as long as American health care is anything other than perfect, Republicans will keep telling people that whatever's wrong is the fault of that socialist Obama's big government takeover.

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