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How the GOP Made the ACA Popular

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There are two fundamental paradoxes that created political problems for the Affordable Care Act. The first is that while as a whole the American health care system as a whole is horribly inefficient and inequitable, large numbers of politically important people (most notably, people with Medicare and good employer-provided insurance) are personally happy with the status quo. The second is that the individual components of the ACA were mostly very popular even though the law itself was not.

Republican efforts to repeal the ACA have, however, completely transformed the debate:

As President Donald Trump and the Republicans in Congress gear up for another attempt at repealing and replacing Obamacare, an ABC News/Washington Post poll finds broad public preference for keeping and improving it — including high levels of support for some of its key components.

Just 37 percent of Americans in the national survey say Obamacare should be repealed and replaced; 61 percent say it should be kept and fixed instead. Even more broadly, the public by 79-13 percent says Trump should seek to make the current law work as well as possible, not to make it fail as soon as possible, a strategy he’s suggested.

Both the status quo bias that makes any major change to health care laws enormously difficult and the popularity of the ACA’s components are now working in the law’s favor, and will make the specific Republican proposals even less popular than repeal in the abstract. I would make an Overton Window joke only the Republicans didn’t. even. try. to sell their real alternative (health care rationed by the glories of the Free Market) because it’s massively unpopular, and cynically attacked the ACA from the left instead. With a Republican in the White House the shell game doesn’t work.

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  • jim, some guy in iowa

    Americans, what do you do about us? We spent what- six years thinking “2 + 2 = 3” and voting accordingly, and now that trump et al wants us to believe “4 – 5 = 11” we all of a sudden came to realize 2 + 2 *does* actually equal 4

    • N__B

      As we learned in this election, “Freedom is the freedom to say that two plus two makes three.”

      • Ronan

        Was the lesson not 2 plus 2 equals 3 because foreigners stole a 1 ?

        • efgoldman

          +1

    • Ronan

      Make America numerate again !

    • SNF

      There’s a lot of evidence that public opinion works like a thermostat.

      If a Republican is president, people have more support for progressive ideas. When a Democrat is president, people have more support for conservative ideas.

      It’s kind of a baffling concept but it seems to be a powerful force. Polls on issues really do swing pretty strongly when the White House changes parties.

  • Yes. As many have pointed out, the actual Republican objection to the ACA is the taxes on rich people. They spilled the beans when they said publicly that repealing the ACA was a necessary head start on tax cuts. But providing affordable health insurance to everybody, while getting higher cost/higher risk people into the pool, costs money. Which has to come from somewhere. There is no way out of this for them.

  • Joe_JP

    individual components of the ACA were mostly very popular even though the law itself was not

    The law’s popularity index is large as a result of scare tactics, ignorance and inability to accept that you take the good with the bad/imperfect (or vegetables with your dessert) IRL.

    Then, there is the fact that it has various things in it that people like. The Republicans don’t like many of these things. They also have been shown to not be able to actually govern that well & seem particularly concerned about tax breaks for some people. Trusting Trump to do anything right is also not something sane people would generally rely upon.

    Finally, it’s like the media making Hillary Clinton a target. They figured she’d win, and deep down, they actually support her policies a lot more than the other side’s. They can attack her though, since she would win, if in a weakened condition. But, oh well, she didn’t win. Stuck with shit. Can’t just carp around the edges any more, can we?

    • CP

      The law’s popularity index is large as a result of scare tactics, ignorance and inability to accept that you take the good with the bad/imperfect (or vegetables with your dessert) IRL.

      I think there’s also a thing about national mythology and national reality being 180 degrees apart. That is, people “know” that they’re supposed to believe in rugged individualism and personal achievement and the free market to deliver everything in their lives, and that people who depend on safety nets like the ACA are losers and deadbeats, and are perfectly willing to listen to bullshit about these kinds of things and even pretend to believe it and pretend that they don’t depend on the safety nets… Until the moment when the safety net becomes threatened, and then the reality slaps them in the face again.

      IOW, it was easier to hate the ACA for the last six years when you knew it wasn’t going away than it is to hate it now when you’re facing the possibility of reality without it.

  • Murc

    I have to admit, I’m legitimately, 100% surprised the Republicans couldn’t repeal the ACA. I had just assumed that the rest of the caucus would cave to the teahadis lest they end up like Eric Cantor, and basically that would be that.

    It turns out I completely misjudged the dynamics of the Republicans actually being in power and having ostensible governing responsibility, and that they found something they fear more than their right flanks. I admit it; I was wrong. It turns out entitlements that are at least somewhat broadly distributed throughout society and not explicitly structured as only being “welfare” for “the poors” really are damned hard to kill.

    Bill Kristol was right back in the 90s. Who knew?

    The second is that the individual components of the ACA were mostly very popular even though the law itself was not.

    Worth noting: the one part of the law that everyone hates (the individual mandate, which is grotesquely unpopular) is also the linchpin required to make the rest of the law work, and also the one thing that insurance companies really love.

    • Manny Kant

      Kriatol was maybe half-right, but in an incredibly stupid and short-sighted way. Yes, national healthcare is hard to repeal. But there was no reason whatever that Republicans would have to pay a political price for that. Only thing making this a political disaster for GOP is their own insistence on repealing the law. People only vote for Dems to protect entitlements when GOP is threatening them. If GOP would just act like a normal center-right party, there’d be no dilemma.

      • efgoldman

        Only thing making this a political disaster for GOP is their own insistence on repealing the law.

        Well, that and the fact that being an ineffective majority, unable to legislate, unable to compromise (necessary for over 200 years, except for that little problem in the middle of the 19th century), “led” by an ideologically corrupt, feckless “speaker”, has left them paralyzed politically, yeah.
        Add to that the worst, stupidest, most ignorant, probably mentally damaged “president” ever as leader of your party, and there you are.

    • sibusisodan

      Well put. Would it be fair to say the Tea Party take over of the wider party is not complete? So there is a sizeable caucus whose biggest threat is not the TP but their constituents?

      The sheer inability of the Republican House to actually handle parliamentary business now that there are no obstacles to implementing legislation is pretty stunning.

      • Murc

        The sheer inability of the Republican House to actually handle parliamentary business now that there are no obstacles to implementing legislation is pretty stunning.

        It turns out the ideological differences between the billionaires who want to kill the rest of us and take all our money, and the billionaires who want to keep us just alive enough to make more money in the long term, are deeper and more contentious than we previously imagined.

        • sibusisodan

          Which one has the first round draft pick this year? I’m worried it’s Team BWWTKTROUATAOM (Go Fighting Megalomaniacs!).

      • imwithher

        “…they found something they fear more than their right flanks…”

        “…a sizeable caucus whose biggest threat is not the TP but their constituents…”

        All Congressmen fear their constituents. It is just that those GOP Congressmen from heavy TP districts fear their primary constituents, and weakness on their right flanks, in the form of super extremist right wing primary challengers, more than they do the entirety of their constituents, and weakness on their left, in the form of their Dem opponent in the general election. The TP Caucus opposed the bill because it was not draconian and nasty ENOUGH. Whereas the “Tuesday Group” (Blue or purple State “moderate” Republicans) opposed because it was too draconian and nasty. Because they fear the Dem opponent in the general more than, or, at least, as much as, they fear a TP challenger in the primary. It doesn’t do you much good to be further to the right than Genghis Khan, and thus win in April, only to lose in November to a centrist Dem, because you stripped too many people of their health insurance.

        • sibusisodan

          Yes, absolutely.

        • randy khan

          And, of course, the TP faction is constitutionally unable to take half, or even 3/4 of a loaf, which makes compromise with them very difficult.

          It also didn’t help that the White House started threatening people and had very little idea what kind of bill it really wanted. (Pretty odd that those two things happened at once, but contradiction seems to be SOP for these folks.)

        • efgoldman

          Whereas the “Tuesday Group” (Blue or purple State “moderate” Republicans) opposed because it was too draconian and nasty.

          And many of the Tuesday klowns come from districts that HRC won.

    • My best guess is that the problem was not with the ACA being impossible to repeal, but with Paul Ryan’s legislative strategy. I think he would have been more successful with a full repeal. The problem is that a full repeal can’t be passed by reconciliation. Regardless, I think he would have done better to just dig up one of the many repeal bills that passed the House since 2010, pass that, and let Mitch McConnell figure the rest out.

      • Pat

        And it would have gone down in flames.

        • Scott Lemieux

          This also assumes that repeal-no-replace could pass the House with a Republican in the White House, which is extremely dubious.

      • imwithher

        What good would that have done? The point is that merely posturing is no longer good enough. Passing a bill subject to the filibuster, and one that will be filibustered like a straight repeal of the ACA, would have been seen as worse than useless. The folks who want the ACA repealed wanted it repealed before it was enacted. And then they thought that a GOP-majority SCOTUS would do the job for them. And then they thought that winning the House would do the trick. And then they thought that winning the Senate would finally do it. Over and over, they were told that repeal was just around the corner, and this time, if you just vote for us one more time, we will shut down the government, and make it stick, if that mean ‘ol Obama doesn’t give us our way.

        Well, now they control the House, the Senate, and the Presidency. From their POV, the anti Obamacare assholes have been lied to, again and again. Just keep voting for us, the GOP says, and we will repeal that awful Obamacare. But it hasn’t happened. Even now, when the GOP literally controls both parts of the legislative branch, and the other two branches as well.

        A “legislative strategy” of straight repeal, that just punted the whole thing up to the Senate, where it would inevitably and quite predictably fall to the filibuster, was not going to make anyone in this crew happy. Talk about “Didn’t. Even. Try!”

      • djw

        My best guess is that the problem was not with the ACA being impossible to repeal, but with Paul Ryan’s legislative strategy.

        I remain convinced that while Paul Ryan is clearly a poor strategist and in well over his head, and that certainly didn’t help, the obstacles to repeal were much more fundamental than that. The Republicans just don’t have any kind of agreement at all about what to do about health care, which led to a dog’s breakfast of a replacement bill that no one actually liked, within the party, the broader conservative movement, or the public at large.

        • NonyNony

          The Republicans just don’t have any kind of agreement at all about what to do about health care

          ^This

          They are not unified. And it’s their own damn fault because they decided that “Attack Obama at any cost” was the only thing they needed.

          Now they’re the dog that caught the car. They don’t know what to do with it.

      • efgoldman

        the problem was not with the ACA being impossible to repeal, but with Paul Ryan’s legislative strategy.

        When we’re talking about Granny Starver, I think both “speaker” and “legislative strategy” belong in quotation marks.
        When i think of the likes of Sam Rayburn, or even John McCormack and Tip O’Neill, the descent of the speakership into fecklessness and irrelevance since Newtie, under RWNJ majorities, is just astonishing.
        I’m glad because incompetence on their side is good for our side, but institutionally it’s hideous.

    • Dilan Esper

      Same here, I was totally wrong about this aspect of Obamacare, and Obamacare advocates were, in the main, right.

    • Bethesda 1971

      Agreed in part (the “Big Yellow Taxi” Effect – “Don’t it always seem to go, you don’t realize what you’ve got till it’s gone.”)

      But wasn’t the purism of the Freedom Caucus for complete repeal or sadistic cuts as much or more the cause of the AHCA failure than the queasy moderate Republicans? (in the House at least)

      • NeonTrotsky

        There are enough of both moderates and freedom caucus members for either faction in either chamber to individually block a repeal, assuming the Democrats are universally opposed as well. Any concessions to one faction simply made the other one more opposed, because they have opposing goals. The “moderates” are really just congresspeople worried they’ll get the boot if millions of people lose their healthcare, whereas the freedom caucus wanted a complete no negotiations repeal of the ACA either because they are true believers or are complete whores to their wealthy donors..

        • imwithher

          The “moderates” are really just congresspeople worried they’ll get the boot if millions of people lose their healthcare, whereas the freedom caucus wanted a complete no negotiations repeal of the ACA either because they are true believers or are complete whores to their wealthy donors..

          Meh, they are all worried about getting the boot. The HFC members are worried that they will be primaried from the right if they sign off on less than total repeal.

        • Bethesda 1971

          you’re right. I should have put quotes around “moderates.” I do think you can be both a true believer and a whore, because the “Johns” themselves are true believers.

        • efgoldman

          The “moderates” are really just congresspeople worried they’ll get the boot if millions of people lose their healthcare

          Maybe a few of them – three or four – also think it’s the right thing to do.

          Hahahahahah I slay me!

      • njorl

        I agree.
        The far-right’s best political option is to demand an unachievable result. Their constituents want Obamacare repealed, and also want to continue receiving its benefits. Publicly posturing for the unattainable “complete repeal” is their best path.

        • Pat

          Much like the purists on the left…

        • imwithher

          Yeah, ironically, it is the Tuesday Group that has the most to fear from the gridlock. Because they have to walk a tightrope between their primary constituents and their general election constituents. They can’t be seen as too soft on Obamacare, or they could lose to a fireeater in the GOP primary. But if they actually succeed in repealing Obamacare they might lose in the general, as folks are outraged over losing coverage.

          Whereas the TP Congressmen from safe GOP districts have only to worry about their right flanks. It seems unlikely that they are going to lose a primary based on being too intransigent in their demand for full repeal.

      • I think it would be better to say the contradictions within the party guaranteed there couldn’t be a solution they all could vote for, just as with immigration. Getting more Freedom votes would have lost more queasy ones, and conversely.

  • Bob

    I found my Facebook feed fascinating in the months after the election. I have several hundred “friends” on fb and they range from insane Tea Partiers to ultra-left. From the day the ACA was passed my feed was filled with outraged anti-ACA screeds from wingnuts – the majority of whom directly benefited from it.
    Then an odd thing happened – Trump won. I honestly don’t think I’ve seen one anti ACA post since. It’s almost as if as long as the ACA was safe they could continue complaining but the moment the calculus changed and it looked as though it might be overturned they got real quiet.
    It makes me question the polling on the ACA. So many people were dead set against it until it actually kicked in. Once they found out they personally benefited they continued to complain while reaping the benefits, seemingly secure in the knowledge it wasn’t going away. I wonder how many of the “Repeal” claimants in polls fall into this category.

    • randy khan

      Lucky you.

      More seriously, what I saw after the election was the militant Trumpistas insisting that the ACA reform would be really great and, when the problems in the actual bill were pointed out, first saying they weren’t real problems and then saying it was just the starting point. It was pretty funny, actually.

  • Uneekness

    The fundamental political problem of the ACA is that it was a technocrat’s solution to health care in America. “Put everybody in the shitty American system of medical insurance, some of which we will pay for,” they said. And they topped it off with a bit of fear of the deficit scold: “But we won’t pay for too much, lest voters punish us for increasing the deficit.” So we got a perfect reverse Goldilocks: just popular enough to stay viable but not be seen as a true benefit worth defending.

    The GOP jumped on the “this isn’t benefit enough” train with their crocodile tears about premium costs and deductibles and insurers leaving the market this past election cycle, and sure it clearly won them votes. But now those voters expect them to deliver a solution to the problem the GOP insisted that it cared about. And there isn’t one (at least not one that contains the all-important tax cut.)

    • FlipYrWhig

      Republicans mostly complained that it was welfare, and still think it’s welfare, because they are stupid resentment-fueled racists from top to bottom.

    • Steve LaBonne

      That’s a political feature, not a political bug. Given the massive deep-pocketed stakeholders in the existing system, there is literally no other way it could have been done or can be done in the future. I just read a very interesting Vox article about Singapore which made the points 1) The insurance part of their scheme can look superficially like a free marketeer’s dream only because 2) the provision part is mostly public which keeps costs way lower than ours, and 3) at the time Singapore was gaining its independence the tehchnocrats realized that the government must never relinquish control over most health care provision because otherwise, it would never be able to control massive cost inflation caused by private stakeholders who would become too powerful to rein in. But for us, that ship sailed long ago, and you can’t get there from here (if I may use two resounding cliches in one sentence).

      • Joe_JP

        Yes. I would replace “technocrat’s solution” with “realistic solution.” The result is imperfection. Easy to carp. This was seen since the Founding, where the imperfections of the Constitution was easy to carp about. We still are. There are better ways there too, but wouldn’t trust the people in control now at a constitutional convention though.

        • efgoldman

          I would replace “technocrat’s solution” with “realistic solution.” The result is imperfection.

          You have to pass legislation with the senators you have, not the senators you wish you had.

    • Scott Lemieux

      The fundamental political problem of the ACA is that it was a technocrat’s solution to health care in America.

      The sell-by date of this analysis has pretty clearly expired.

      • Uneekness

        Ugh. We get it. WE GET IT! Something something Joe Lieberman. Yes, the ACA was policymaking in all its sausage-iest glory. But Jesus Christ on a crutch it was a technocrat’s wet dream approach to finding a solution. Saying so doesn’t denigrate the political achievement of getting something, anything across the finish line when it comes to health care policy in America. And recognizing that the ACA’s particular approach is, by its very design, confusing and complex and has many, many pain points for ordinary users demonstrates the limits of a technocratic solution without diminishing the fact that it still an improvement over the status quo.

        This policy was designed by wonks who know what a pivot table is. Nerds who believed that getting all of their equations to zero out was an indication that they had laid the foundation for a successful policy, because the rational actors who it affected would recognize the increase in marginal utility in their lives. (Or something. I’m not a nerd.) You’re getting kinda-decent insurance! At market rates! Or subsidized – a lot, or maybe a little. How much are you going to make next year? Don’t worry, if you screw this up we’ll make you pay it all back when you do your taxes next year. It’s fine! No, prescription drugs don’t count towards your deductible, why’d ya ask? Sure you live in flyover country and only have one provider left in your area and your premiums went up 40% but if you look at the country as a whole, they only went up 12% so don’t throw the baby out with the bathwater!

        The ACA’s popularity has barely broken even not due to the incessant lying and scare-mongering from the right (although it certainly assists). It is unpopular because it is complicated and often still very expensive.

        Why is it so easy to understand that the things that make a GOP candidate viable in a primary can make him or her terrible for a general election, yet it is so difficult to acknowledge that the stuff that made the ACA sellable to Democratic representatives and senators ended up making it far less successful from a general political standpoint – it has been an anchor on Democratic political fortunes for three election cycles.

        • sibusisodan

          This policy was designed by wonks who know what a pivot table is.

          The rest of your paragraph does not support this statement. In fact, most of your complaint is not about techno-wonkery, but legislative roadblocks.

          The ACA is a kludge precisely because it is a pragmatic piece of legislation which buys off the necessary stakeholders in order to improve aggregate health outcomes. Its many limitations are thus a product of political realities, not ideological blinders.

          I mean, do you really think there are healthcare policy experts who think that having a state insurance market in Wyoming is the best idea?

          • Uneekness

            Policy option A: The minimum wage should be $15/hr

            Policy option B: Wage supports, indexed to regional cost of living in distinct geographical areas, that create no less than two standard deviations in outcomes from a total wage that is no less than 85% of an annually adjusted determination of cost of living in order to provide a local living wage

            Am I allowed to call one of them a technocratic solution, boss?

            • Hogan

              Not responsive.

              PPACA was not designed by policy wonks and then brought to Congress for a vote. It was designed by logrolling legislators and lobbyists, with some input from policy wonks, and ended up winning the race for 60 Senate votes. If that’s technocracy, then the word is meaningless.

              • Uneekness

                So, it sprung from Max Baucus’ head, Athena to his Zeus? No Jon Grubers around at all, I guess.

                • Hogan

                  Um. Do you have reading knowledge of English? Stamp your hoof once for yes and twice for no.

                • Uneekness

                  Look, I get that determinism is a big deal around here when it comes to the ACA. Fine. But some of us understand that legislators actually get to make real choices in how they decide to start crafting policy. There were options that were left off the table, for various reasons, but mostly because “there is no way (Horrible legislator A/Horrible Legislator B/etc./etc.) will let that out of committee/will vote for it on the floor. Valid reasons, all!

                  So they cast about for a way to achieve said policy goal. In this case it was, “hey, if we can’t just ensure access to healthcare via a giant overhaul like single payer, or expansions of Medicare or Medicaid, how about we start with this wonk policy idea: a too-clever-by-a-half way to pour everybody into the individual insurance market as a backdoor way to universal coverage while still claiming that it is an entirely private marketplace.” The starting point chosen was a highly technical workaround to persistent legislative veto points. Hooray! Something passed! And because legislators talked about it and changed it some in committee it has nothing to do with the people and organizations who conceived the ideas and first put them into circulation!

                  *Unless it came from a Koch organization, or some other industry special interest. Those bills are always and forever “bills crafted by lobbyists” and can be safely viewed with derision.

                  Not the ACA though. It’s the best possible bill because it’s what passed so it can only be the best possible bill or it wouldn’t have passed so duh.

                • Scott Lemieux

                  hey, if we can’t just ensure access to healthcare via a giant overhaul like single payer, or expansions of Medicare or Medicaid…pour everybody into the individual insurance market

                  The fact that you have absolutely no idea what you’re talking about tends to limit the value of your assertions that a significantly better policy could have passed.

                • Uneekness

                  Sigh…

                  That the policy is overly complex is the problem. That it is overly complex because that is how it could pass is irrelevant. You seem to not understand that choosing an overly technical solution because of political expediency within the legislative body does not actually make said overly technical solution any less of an overly technical solution.

                  You know who does see at as an overly technical solution? The people for whom it is confusing and difficult to use AND can still be quite expensive. For some reason, knowing that it was impossible to do better because argle bargle Lieberman doesn’t comfort them! They seem to just see a crappy, technocratic half solution that isn’t really of great value to them. Which the GOP has happily made hay with at the polls for he last three election cycles.

                  Pointing out that the solution to the legislative problem – a wonky, technocratic policy – turned out to create a new problem for Dems at the ballot box is weirdly threatening to you for some reason.

                • sibusisodan

                  You seem to not understand that choosing an overly technical solution because of political expediency within the legislative body does not actually make said overly technical solution any less of an overly technical solution.

                  But if the technical solution is chosen because it fits the highly constrained political parameters, then its not overly technical. It’s appropriately technical.

                  Since healthcare is 17% of US GDP, any political solution is going to be complex.

                  The idea that the reason for policy complexity – so it could pass – is precisely the issue to look at if your problem is that complexity.

                  This is, as you imply, no comfort whatsoever to someone at the sharp end of the ACAs problems.

                  But the solution to those problems lies in Congress, not policy shops. That’s the limiting factor here.

          • Scott Lemieux

            I mean, do you really think there are healthcare policy experts who think that having a state insurance market in Wyoming is the best idea?

            Exactly. There wasn;t a national exchange –which a majority of Democrats in both houses favored — almost entirely because of the distinctly non-technocratic Ben Nelson.

            • Uneekness

              Well that seals it, then. Alert the rural working poor! This policy is actually simple and easy for you to use because there are no healthcare policy experts who think that having a state insurance market in Wyoming is the best idea! Your anger is misplaced!

              • sibusisodan

                Well, yes, the anger is misplaced. It wasn’t technocrats who designed this kludge.

                Doesn’t mean the anger isn’t justified though.

        • PunditusMaximus

          My problem with the ACA is that it is a neoliberal technocrat’s solution – highly educated and competent and doomed to fail and hurt people because of unexamined market-worshipping assumptions.

          That is not why it was unpopular. It was unpopular because Obama is black.

          • Uneekness

            Or…

            It can be unpopular because it isn’t that great AND he’s black. They aren’t mutually exclusive! Old white racists like them some Medicare after all.

            • PunditusMaximus

              “Keep your black government hands off my Medicare.”

            • efgoldman

              It can be unpopular because it isn’t that great AND he’s black.

              It was unpopular because the RWNJ noise machine slagged on it ceaselessly.
              Did you happen to notice what transpired when Granny Starver and the Humanitarians actually tried to repeal it? It was in all the papers, you probably saw it.
              You clearly have no idea how politics and the process of creating legislation in this country work. Go read some history and political science and then come back and talk to the adults.

              • Uneekness

                Did I notice that the ACA became barely more popular, even as the RWNJ noise machine continued to slag on it ceaselessly even as we speak? (Side note: if the RWNJ noise machine is all it takes to drive the bus on how the public feels about the ACA, shouldn’t Trump’s idea to kill the ACA via executive malfeasance and say the Democrats are at fault be easy-peasy to execute?) The GOP painted themselves into a corner by promising “better and cheaper” to everyone, which is impossible. That and the fact that they have no institutional memory/capacity amongst their leadership about how to craft actual policy.

                It doesn’t mean the ACA is safe at all. Counting on the GOP to always shoot themselves in the foot isn’t a long-term strategy. I’d prefer we not give them the chance to wield the gun.

  • Jonny Scrum-half

    I think that the takeaway on this and many other issues is that propaganda works. The Republicans/conservatives/right wing have a relentless, well-funded propaganda machine spread across the airwaves, print and the Internet that hardens their base and influences mainstream media.

    • efgoldman

      the takeaway on this and many other issues is that propaganda works.

      Except it didn’t. The ACA is still in place, and it looks less and less vulnerable with each passing week.

  • Thrax

    cynically attacked the ACA from the left instead

    Yeah, this is important, and not remembered enough. In the 2010, 2012, and 2014 elections, Republicans endlessly flayed the ACA for supposedly cutting Medicare. (The cuts were actually to Medicare Advantage, not traditional Medicare, but never mind that.) The GOP now claims the people don’t want government involvement in their healthcare, but their main attack line has been: the ACA cuts government support for health care. Naturally, none of the various GOP proposals would undo those cuts.

    Premiums are a similar story, if slightly more complicated. Premiums under the ACA are too high, the GOP says. What would their proposed bills do to lower premiums? Nothing, though they would enable extremely cheap, extremely crappy insurance that, I’m guessing, would be touted as “lower premium.” (Said insurance would likely also feature enormous deductibles, of course, which the GOP has also criticized ACA plans for.)

    The current GOP position is that the public wants health-care policy to move to the right, but their campaign messages have attacked the ACA from the left. No surprise that the public isn’t too excited about the GOP “alternative.”

  • nemdam

    Wait, are you telling me the law didn’t get more popular because of messaging? Everything I know about politics is turned upside down.

    • Scott Lemieux

      It sure is amazing how Republican messaging got far worse and Democratic messaging got much better starting in February 2017.

  • Asteroid_Strike_Brexit

    Even more broadly, the public by 79-13 percent says Trump should seek to make the current law work as well as possible, not to make it fail as soon as possible, a strategy he’s suggested.

    Everybody knows true conservatism is about smashing currently existing things to pieces and replacing them with a void. How did we reach the point where ‘a strategy’ of making healthcare fail is considered a valid policy?

  • DrDick

    There is a delicious irony in the fact that Republican efforts to destroy the ACA may be what saves and strengthens it.

  • DamnYankees

    While I want to take a victory lap as a guy who said that the GOP would never repeal Obamacare, I think the best way to understand what happened is not that the GOP base ever really hated Obamacare as a policy and then changed their minds. They just hated the Obama part of it.

    It’s been interesting to watch how little the GOP base cares about almost any of the economic issues that the GOP claims to be about, and yet watch as no one – including both Republicans and reporters – understand what’s going on. It’s not that the GOP base changed their mind – it’s that they simply never cared about this policy to begin with, and are more than happy to flip on substance when someone “like them” is in charge of it.

    I know I’m preaching to the choir here, but as well know the GOP is essentially structured as a thin layer of very rich people ruling over a giant mass of traditionalist (e.g. racial, religious, gender, etc.) resentment. They don’t share very much in common, culturally. The rich people think that the GOP is defined by its economic ideas, while the base think its defined by its cultural identity. It’s been working this way for years of course, but with Trump it’s getting more interesting because he *ran* more than anyone before as one of the members of the *base*, but now that he’s in office he’s essentially been captured by the donor class.

    I maintain that the simple best way to explain how the GOP works, and the explanation for what happened here, is that the vast majority of their base simply doesn’t care about the actual substance of almost any of the economic or foreign policy positions of the Republican Party. They don’t give a fuck. There was a recent poll out showing that the number of Americans who want the government to “do more” is at its highest ever, and lots of people were surprised by this and wondering what it meant. I can’t help but think that the answer is so obvious that I don’t get why people are surprised by it. The GOP base’s position on whether the government is good and should do more has nothing to with policy – they don’t think in terms of “this policy is good and we should do more of it”. Their position is entirely driven by “is someone like me in charge – if so, yay government, if not, boo government”. Their ideological believe in the power of government is paper thin. It’s entirely about whose in charge. This is the exact same phenomenon we saw with Syria. And with the GOP position on trade. And with the GOP view of economic confidence.

    Democrats are not like this. When they lose power, they don’t lose their believe in these principles.

    And so of course the GOP base hates the new health care plan, because it is awful, and they have no ideological commitment to the principles causing the awfulness. They don’t give a flying fuck about these ideas in the abstract. They are totally fine with health care so long as a Republican is giving it to them. The fact that any journalist or politician would be surprised by this should be evidence that they barely understand their chosen profession.

    • Murc

      While I want to take a victory lap as a guy who said that the GOP would never repeal Obamacare,

      You should. You were 100% correct and you deserve to bring that up when relevant. To gloat a little bit, even. It’s what I would do.

      • DamnYankees

        Eh, to what end. I just remain amazed how many people don’t realize that one of the top 3 most important facts about the last 10 years of politics has been the staggering level of bad faith shown by the GOP. it started immediately once Obama was elected (much less inaugurated) and has continued to this day. It was incredibly obvious then and it remains obvious now.

        Bad faith can get you very far in politics. But it has pretty obvious implications for governing, and the GOP’s failure to repeal Obamacare seemed like a very clear one to me.

        • PunditusMaximus

          Is our Democrats learning?

    • Karen24

      Please gloat a lot! And your analysis is spot-on. It’s only with the election of Trump that I’ve understood how accurate what you say is. They don’t hate the policies I want; they hate ME — a professional, outspoken woman. Nothing I could say would change the fact that my very existence is a problem for Trump voters. It’s not a pleasant to know that slightly under half my fellow citizens hate me.

      • Bill Murray

        It’s not a pleasant to know that slightly under half my fellow citizens hate me.

        Trump only received ~27% of the vote of those eligible to vote, which is significantly less than half of citizens. So only a quarter hate you enough to get out and vote, which is still not pleasant

      • The Lorax

        Yeah, but we like you a whole lot. So on net you’re still liked.

      • PunditusMaximus

        Welcome to being a woman or POC?

        • pseudalicious

          She… literally just said she’s a woman. Has been all her life.

          • PunditusMaximus

            My badd, srsly.

    • CP

      It’s been interesting to watch how little the GOP base cares about almost any of the economic issues that the GOP claims to be about, and yet watch as no one – including both Republicans and reporters – understand what’s going on. It’s not that the GOP base changed their mind – it’s that they simply never cared about this policy to begin with, and are more than happy to flip on substance when someone “like them” is in charge of it.

      Whatever his inadequacies, I think Trump, at least, understood this perfectly, and that this is key to what led the Republican electorate to channel-surf past sixteen other candidates and overwhelmingly choose him. Trump understands what the average conservative voter cares about – bigotry – and gave it to them louder and prouder than anyone since George Wallace, making Mexican “rapists and murderers” and “thousands of Muslims celebrating in New Jersey” the key theme of his campaign rather than some played-out gobbledegook about trickle-down economics.

      (I was watching this play out in real time throughout the primaries with the few conservatives I knew – people who fancy themselves “principled” and deep thinkers, very much not first-hour Trump supporters – and their incomprehension at how a person they thought was Not A True Conservative could possibly be sweeping up so many voters).

      I also think this is quite possibly the reason Trump said “okay, ram it through by this weekend, we’re not going to piss away a year talking about this.” Because he understands that his voters don’t fundamentally give a shit about the ACA. If you can ram it through, OK, fine, but if you can’t, you can’t, and we’re not going to spend any more time than we have to talking about a non-issue. That’s not what my audience is all about.

      And this is related to the fact that not all that many people really understand, or are interested in putting in the time to understand, things like economics and government finances, even from the simplified and wrong point of view put forward by the National Review. It’s too boring. They want simple, black-and-white narratives of good guys and bad guys, telling them who to blame for all their problems, preferably in terms that reinforce rather than challenge their prejudices. And this phenomenon is strongest in the GOP, where they’ve been cultivating it for decades.

      • DamnYankees

        Whatever his inadequacies, I think Trump, at least, understood this perfectly, and that this is key to what led the Republican electorate to channel-surf past sixteen other candidates and overwhelmingly choose him. Trump understands what the average conservative voter cares about – bigotry – and gave it to them louder and prouder than anyone since George Wallace, making Mexican “rapists and murderers” and “thousands of Muslims celebrating in New Jersey” the key theme of his campaign rather than some played-out gobbledegook about trickle-down economics.

        My only disagreement here is your use of the word “understands”. I don’t think Trump actually understands this at all. He just bet on it and benefited from it.

        Steven Bannon probably understands it though.

    • Rob in CT

      I maintain that the simple best way to explain how the GOP works, and the explanation for what happened here, is that the vast majority of their base simply doesn’t care about the actual substance of almost any of the economic or foreign policy positions of the Republican Party. They don’t give a fuck. There was a recent poll out showing that the number of Americans who want the government to “do more” is at its highest ever, and lots of people were surprised by this and wondering what it meant. I can’t help but think that the answer is so obvious that I don’t get why people are surprised by it. The GOP base’s position on whether the government is good and should do more has nothing to with policy – they don’t think in terms of “this policy is good and we should do more of it”. Their position is entirely driven by “is someone like me in charge – if so, yay government, if not, boo government”. Their ideological believe in the power of government is paper thin. It’s entirely about whose in charge. This is the exact same phenomenon we saw with Syria. And with the GOP position on trade. And with the GOP view of economic confidence.

      This seems right, and it’s utterly infuriating.

      • DamnYankees

        It’s why I’m incredibly skeptical of any approach which says that in order to get people back on the Democratic side we need better economic policies. I don’t see evidence for it. I just don’t any evidence that people are broadly more willing to cross parties to vote for people who are better for them economically at a national level.

        • Bill Murray

          sure, broadly more willing is never going to happen, but Secretary Clinton needed 0.5-1% more willing, which is not exactly broadly more willing

          • Linnaeus

            Agreed. The margins matter, especially in districts where Democrats can’t be assured that their core constituencies will be sufficient to win.

            Plus, it’s the right thing to do.

    • xq

      It’s not that Republican voters don’t care about the stated economic policy of the GOP, it’s that a large chunk of Republican voters are opposed to it. If they didn’t care, Republicans could pass whatever healthcare bill they wanted and be fine.

      Healthcare is not like foreign policy or trade. It’s on the opposite end of the scale. Voters have strong preferences on healthcare that limit policy flexibility.

      • Scott Lemieux

        Or upper-class tax cuts, which even if non-wealthy Republicans oppose don’t affect them directly.

  • sibusisodan

    Their ideological believe in the power of government is paper thin. It’s entirely about whose in charge

    As an outside observer, it’s taken me quite a while to grasp this, especially with foreign policy.

    It’s rather disturbing. Everything is not now OK now VP Republican has given North Korea the full Blue Steel. It’s crazy.

    • DamnYankees

      Just to be clear, it’s not that conservatives don’t have deep beliefs. They do. They are just about different topics. The battle between liberals and conservatives in America is not one where both sides care about an issue and disagree about how to do it. The battle is between which ideas are even important in the first place.

      Xenophobia and traditional authority structures are just incredibly important to conservatives. Liberals tend to not think of those things as ‘policies’, and so they don’t see the GOP’s belief in them as a policy dispute. But that’s the reality.

  • PunditusMaximus

    1) the President is no longer a poc.

    2) there is no (2).

    Is our Democrats learning?

    • randy khan

      So, nominate a white guy the next time?

      • Scott Lemieux

        Yeah, Republicans would have loved the ACA if Joe Biden had signed it.

      • PunditusMaximus

        Don’t nominate a black guy and expect the white supremacists to play nice. Don’t think it’s about policy. And don’t appoint Republican daddies.

    • Rob in CT

      While Obama’s blackness amped things up a bit for some, fundamentally it’s because the other tribe – Democrats – did it. When their tribe, Republicans, is in charge, things magically change.

      That tribal identity is all sorts of tied up with race. But they hated Bill Clinton (and Hillary, oh my!) passionately too.

      • Rob in CT

        And to be clear, I’m talking about a large chunk of the GOP rank and file voters & swing voters who put Trump in the WH, not GOP “thought leaders” and elected officials. That crowd has a fair # of true believers.

      • CP

        Yep.

        They hated Obama because he was a [racial expletive deleted].

        They hated Clinton because he was a [racial expletive deleted]-lover.

        It’s totally about tribal identity; the tribal identity is totally wrapped up in race; and running a white male Southern-accented face will do nothing to help, because it’ll still be the Others’ party, whoever the public face is.

  • large numbers of politically important people (most notably, people with Medicare and good employer-provided insurance) are personally happy with the status quo

    That’s what Obama meant by “If you like your policy you can keep it” and it’s still true (unfortunately all the people with abusive “catastrophic” plans on the individual market started claiming that they liked their plans too, though if they really did like them they were crazy). It was by taking care of those people (of whom, full disclosure, I’m one) that Kennedy and Baucus and Obama fashioned a program that could withstand repeal attempts, and by co-opting insurance companies into the system.

    • SNF

      I imagine some of the people with catastrophic plans didn’t realize how bad their coverage was because they hadn’t had to use it yet.

      Which means they were angry about having to switch to more expensive coverage because they thought their coverage was already great.

  • smartone

    Obama finally had the right answer for Republicans ACA hate — but unfortunately it was after he left office !

    Obama say ” if Republicans can pass a better bill then ACA he would disavow ACA and fully support the Republican bill .”

    He finally called their shit and we saw the results

    too bad Obama didn’t do this in 2010

    • PunditusMaximus

      We got the best result on the ACA we could reasonably hope for, given that Republicans are deranged.

    • Dave W.

      too bad Obama didn’t do this in 2010

      He did. On national television, no less. And was sufficiently successful that the Republicans never again invited him to talk to their caucus with cameras present. How soon we forget.

      “I’ve read your legislation. I take a look at this stuff. And the good ideas we take,” Obama said. “It can’t be all or nothing, one way or the other … If we put together a stimulus package in which a third of it is tax cuts that normally you guys would support, and support for states and the unemployed and helping people stay on COBRA, that certainly your governors would support … and maybe there are some things in there, with respect to infrastructure, that you don’t like … If there’s uniform opposition because the Republican caucus doesn’t get 100 percent or 80 percent of what you want, then it’s going to be difficult to get a deal done, because that’s not how democracy works.”

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