After a decade of intense political fighting and two of the largest wave elections in history, the United States finally has a quasi-stable political equilibrium on the Affordable Care Act.
We have Obamacare, just minus the deeply unpopular stuff—i.e., the individual mandate and the Cadillac tax on employer-provided insurance. This fills me with both personal vindication, since this what I advocated Democrats pass in 2010, and deep concern because it shows neither major political party has any idea how to make laws popular.
When it comes to big pieces of legislation, they are only as popular as the least popular major provision. Most voters don’t evaluate legislation with a complex utilitarian calculation weighing the net value of every provision. Most judge legislation the way they would a pizza. You could have five amazing toppings on that pizza, but if the sixth topping is rotten fish, no one will want to eat your pizza.
If you understand this axiom and realize none of the so-called political gurus leading either major party in our country do, something becomes clear. The last decade of political fighting over the ACA has been less of a titanic struggle between genius ideological leaders and more of a farcical dark comedy performed by fools.
Democrats’ mass delusion
In 2009-2010, Democrats strongly bought into their own spin, so convinced of their technocratic mastery that they succumbed to mass delusion.
Poll after poll after poll showed Democrats that the ACA was unpopular because of the individual mandate and tax on employer-provided insurance. Yet, instead of jettisoning these provisions, Democrats kept digging deeper into their own self-delusion.
Democrats became dogmatically convinced that only they could see these policies were essential, even though the Congressional Budget Office kept saying without a mandate the system would still work fine, though a bit less efficiently.
Meanwhile, the economic logic behind the tax on employer-provided insurance was grossly naive, since it ignored how the price problem in the U.S. system is mainly due to monopoly power.
Democrats insisted these policies were only unpopular because Republicans made them controversial. However, it was well known these ideas were politically toxic from the beginning. That is why, as a candidate, President Barack Obama hammered Hillary Clinton over her support of the mandate during the 2008 primary and hammered John McCain for his support of taxing employer coverage in the general election.
After Obama spent months telling the public how stupid these ideas were, it was an act of true madness for Democrats to push these same ideas and act like the public was full of economically illiterate rubes somehow tricked by the GOP.
Republicans get high on their own supply
Democrats handed Republicans an amazing political gift in 2010. First, Democrats insisted on passing a big, unpopular law that wouldn’t even go into effect for years. It contained a handful of very unpopular provisions that were perfect for highlighting in stump speeches and attack ads. They played right into the GOP anti-tax, small government brand.
They also did it in a way that deprived them of one of their best political arguments. Before the ACA, Democrats had a real edge on the issue of health care.
Consumer protections were and remain very popular. The recent success of Medicaid expansion ballot measures in very red states shows providing health insurance to low-income people has wide political support. Yet, Democrats implemented some of their most popular long-term campaign promises in one of the least popular forms
Republicans could have banked this as a big win. They could have rallied against the unpopular stuff, made some modest changes to the structure with some elements repealed after they won, and called it victory. Instead, Republicans also engaged in a level of self-delusion that made the 2010 Democratic caucus seem like geniuses by comparison. They convinced themselves that, because the public hated the law for including a mandate, the public somehow hated all the provisions, which they kept telling pollsters they loved.
While Democrats gave the American people a supreme pizza with rotten fish, Republicans tried to give the public a whole plate of barbed wire with a nice tomato sauce.
Most people forget, but the Republicans’ American Health Care Act actually had several elements that, in isolation, were very popular. It ended the very unpopular individual mandate and tax on employer coverage. It provided subsidies to those screwed over by the ACA for making barely more than the threshold. But these very popular provisions were totally overwhelmed by its deeply unpopular provisions, namely cuts to Medicaid and the weakening of consumer protections.
In addition, the GOP pursued the AHCA in the worst possible manner. They debated the unpopular bill for weeks until it appeared to be dead. Then they brought back another, even stupider version. By passing their bill in the House and having it fail by one vote in the Senate, they sent a clear message that if they won in the next election they would try it again. They basically wrote Democrats’ campaign ads for them.
In the end, the GOP dropped all the unpopular stuff. They did a few popular things, namely repealing the individual mandate and tax on employer coverage. By that point, it was too late because the damage was already done.
Has anyone learned a lesson?
Multiple historic wave elections and over a billion dollars spent on ads and political organizing around the issue basically left us with something fairly close to the health care plan Obama actually supported in his 2008 presidential campaign. It’s basically the same plan we would have gotten if Democrats had listened to the polls in 2009.
I hope members of Congress, wonks, and activists have learned a lesson from this ordeal. They should expect all proposals to be judged by their least popular major provision.
If one package is unpopular due to a bad element, don’t expect the exact opposite to be popular, either.
It does not matter how well a Medicare for All plan or climate change plan polls in the abstract if the major parts are not fully developed.
Find a way to bring the public on board for the unpopular parts or find a way to exclude them. Springing the unpopular parts on the public at the last minute is the surest way to a political disaster.