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Obamacare and the Arc of Conservative Wishful Thinking

Posted on June 24, 2013
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In just over three months, you’ll be able to sign up for coverage in health insurance exchanges.  Well, maybe.

The GAO recently found that the Administration is way behind schedule in standing up the exchanges.  Worse still, it appears that fewer insurers than hoped will be offering coverage.  And the New York Times has reported on the problems that the new law is presenting for clinics that serve people with low incomes.

So, other than maybe lacking health insurance marketplaces, insurance companies with plans to market and enough doctors to care for newly insured people, Obamacare implementation is going just fine.

Which suits many conservatives just fine.  But I’m not so sure that standing back and hoping the law’s implementation falls flat will prove an effective strategy.

At the heart of this strategy is the notion embedded in the conservative psyche that the law lacks legitimacy.  Conservatives have crit­i­cized the exclu­sion of Repub­li­cans from writ­ing the bill, the deals the White House cut with health care lobbyists, and the sweet­en­ers infused into the bill to pro­cure 60 Sen­ate votes to show that it was sketchy from the start.  They have chal­lenged the law’s con­sti­tu­tion­al­ity and encour­aged states to resist its imple­men­ta­tion.  The law lacks legitimacy, they reason, and is therefore bound to fall.

They’ve thought that before, though.  Obamacare has survived a series of near-death experiences: Scott Brown’s election, Democrats’ disastrous 2010 elections, a Supreme Court challenge, the 2012 Presidential election, and the refusal of some states to expand Medicaid or create exchanges.  Through it all, its implementation has limped on.

Now the arc of con­ser­v­a­tive wish­ful think­ing reaches its end­point. Hav­ing seen all previous efforts to derail the law fail, this hope only remains: that the law, once imple­mented, will fall of its own weight.

This hope, I fear, will prove illu­sory. Imple­men­ta­tion will make the law’s problems apparent, but won’t lead to its repeal. There are many reasons for this, but the most important one is that the law will ben­e­fit some peo­ple. Can­cer sur­vivors who couldn’t get insur­ance will find cov­er­age. The chron­i­cally unem­ployed – and there are lots of them — will find government-subsidized health insur­ance more afford­able. You can’t spend $1.8 trillion with­out help­ing some­body.  And those sto­ries, along­side tales of the law’s fail­ings, will rever­ber­ate through­out the main­stream and social media.  “It’s a stu­pid law,” peo­ple will say, “but at least Uncle Joe got health insurance.”

It is, of course, pos­si­ble that the present scan­dals or some unfore­seen event will weaken the President’s pop­u­lar­ity to the point that prob­lems with the law’s imple­men­ta­tion will become his Hur­ri­cane Kat­rina. Loss of pub­lic faith in his com­pe­tence could cause erosion of sup­port within his own party, forc­ing him to agree to a sub­stan­tial rewrite of the law. But that pos­si­bil­ity strikes me as remote.

Obamacare, regrettably, will likely survive this latest round of conservative wishful thinking.

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Doug Badger is a former partner in The Nickles Group, a lobbying firm.  Prior to that, he was Deputy Assistant for Legislative Affairs to President George W. Bush.  He helped develop President Bush’s proposal for a Medicare prescription drug benefit and health savings accounts.  He has also served as Chief of Staff to the Senate Republican Whip and to the Republican Policy Committee and held senior positions at HHS and the Social Security Administration. He has recently retired and lives with his wife, Debbie, in Ashburn, VA, where he writes a blog called Doug's Brief Case.