July 19, 2013
Health-care reform supporters rally in Washington. (Charles Dharapak/Associated Press)
Health-care reform supporters rally in front of the Supreme Court.
(Charles Dharapak/Associated Press)

Responding to arguments from Ezra Klein and from me about the future potential lack of popularity of “Obamacare” even if the Affordable Care Act is successful, Brian Beutler just can’t believe it:

[A]t some point, it’ll be like Medicare. Some people who like Medicare might reason that since Lyndon Johnson created Medicare 50 years ago, and he was a Democrat, then the thing to do is vote Democrat. More likely they think “I don’t like that GOP plan to privatize Medicare, so I’m going to vote Democrat.” Either way, unless the Republican party at some point abandons its efforts to devolve social insurance programs, I think comparable constituencies will exist for the ACA.

I want to be careful about where I (and I think Klein) agree, and where there’s disagreement.

Where I think everyone agrees is that once people get benefits, it’s going to be very, very, difficult to take them away.

Where I disagree is that I don’t think it will be like Medicare at all. Here’s Klein:

If the law works, then a decade from now, about 25 million people will be insured through Obamacare. About half of them will be insured through Medicaid. The other half will be insured through state insurance marketplaces with names like “Covered California” and “Health Access CT.” They’ll get this insurance because their minister will mention it to them or because their community health clinic will sign them up. Few of these people are likely to connect their coverage to that Obamacare thing they heard about a lot back in 2010.

Exactly. Those on Medicaid will be on Medicaid. Why would they think of that as “Obamacare” or the ACA? The same more or less will apply to the exchanges. Sure, the first people to sign up will know something is different, but very soon after that, it will just be the way things are, and (as far as they know) always have been. Beyond that, as I argued:

[U]nder the hood, there is all sorts of government intervention going on—all sorts of new regulations about what insurance companies can do, how they must spend their money, what products they are allowed to offer through the exchanges. But that’s all going to become invisible to consumers over time.

My favorite example of this is the old insurance practice of cancelling people’s insurance when they made a claim — “rescissions.” It’s gone now, but not only does no one know that, but the only people who really knew about it in the bad old days were those who found out the hard way. I doubt if one in a million people would give “Obamacare” credit for this very important reform.

Even if voting worked by rewarding parties that built well-liked programs and punished parties that opposed them — and for the most part, it doesn’t actually work that way — the Affordable Care Act is almost perfectly designed to blunt any direct connection between the experiences faced by most people and the law they’ve heard about on the news. And, for better or worse, voting often doesn’t work that way. After all, the party that sponsored a Social Security privatization scheme and a Medicare voucherization seems to be doing quite well with the people who place an especially high value on those programs.

Again, I agree with Beutler that, assuming implementation is even close to as successful as the administration hopes, the ACA is here to stay. If by “political” we’re talking policy, then health-care reform is terribly important politically. But when it comes to electoral politics, I just don’t see it.