Pur Autre Vie

I'm not wrong, I'm just an asshole

Monday, April 03, 2017

The Politics of the Affordable Care Act

Under the Affordable Care Act, insurers must set rates for their plans well in advance. Furthermore, they have to make crucial decisions about what plans to offer in which markets.

Under these circumstances, the Trump administration can essentially cause the system to collapse without lifting a finger. It merely has to create enough policy uncertainty that insurance companies feel compelled to raise rates substantially or pull out of markets. Then Trump can claim that Obamacare has collapsed under its own weight and replace it with Trumpcare. Needless to say, the Trump administration has been extremely effective at creating policy uncertainty.

Now this is dirty, and we shouldn't let them get away with it. But taking a step back, this dynamic puts a rather heavy thumb on the scale in favor of left-wing policies such as single payer or the public option, since the public/private division of labor in the Affordable Care Act is too easy to sabotage. A healthcare system that only works so long as a Democrat is the President is not a good healthcare system.

In fairness to the drafters of the ACA, it doesn't seem as though it should be vulnerable to political maneuvers like the one I've suggested. After all, for the gambit to work, the saboteur has to be a saboteur! He or she has to cause big problems for millions of Americans, which would seemingly be political suicide.

But Trump's election has revealed a terrifying political math in which voters cannot be trusted to see through even the most transparent lies, much less to grasp something as complicated as the health insurance system. We can hope that political pressure forces the administration to behave responsibly, and we can work toward that outcome, but we cannot rely on that outcome.

Now admittedly this logic, taken to its extreme, is a counsel of despair. But I think there are still limits to what people will believe, and responsibility for administering basic public functions like publicly provided medical care (or publicly provided insurance) will probably still be assigned to the President. It is the interplay of government policy and private provision of insurance that makes the ACA particularly vulnerable.

By the way, I make this argument somewhat regretfully, because I usually don't like arguments about substantive policy that boil down to political process. ("We should be tougher on monopolies, it polls really well in Ohio!") But I believe that's the world we live in, and when you are opposed by cynical political forces that have proven themselves highly effective at exploiting a credulous electorate, you ignore political process at your peril.

[Edited to add: I've been thinking about this because apparently the Republicans are cooking up another attempt to repeal the ACA. These are horrible people and we must do everything we can to prevent them from succeeding.]


Blogger Alan said...

You're not wrong.

11:44 AM  
Blogger Zed said...

I'm more skeptical that people (outside of Trump's hardcore base) will buy this. I still find it likelier that marginal voters (who are not especially political) will blame the Trump admin for screwing things up, especially if there is other evidence of their incompetence. The only real evidence against this pov is recent British politics, which is indeed extremely scary but is taking place in a different media climate.

2:41 PM  
Blogger James said...

I think there's a fair amount of evidence that the U.S. electorate has severe deficits in the "assessing evidence and drawing logical conclusions" area. Maybe I didn't make my point clearly enough, but the way the problems will become visible is in actions taken by insurance companies, and in the abstract those problems could be "baked into the cake" of Obamacare (and indeed some of them were surfacing while Obama was President). So in other words, as long as Trump avoids overt actions to destabilize the market, it seems likely he can evade blame with a significant portion of the voters. All he has to do is have the House Republicans periodically "reopen" the issue. In this regard, see:


Whether this would give him sufficient political cover to gut the program is an admittedly harder question.

2:58 PM  
Blogger Zed said...

I'm not suggesting that people can assess evidence, just that they (at least marginal voters, who are largely politically unengaged) tend to reflexively blame the party in charge whenever anything goes wrong. The former claim would indeed be wildly optimistic, but the latter is widely believed by political scientists and seems fairly plausible to me. Swing voters tune out political news to an above-average degree so (in this instance) are less likely to even *hear* spin.

12:58 PM  

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