Maybe the administration and the opponents of Obamacare, at least some of them, had it wrong.
The president and the Democrats who designed Obamacare were certain that the individual mandate coupled with generous subsidies for health-care insurance would cause millions and millions of people to rush forth to get insurance. Republicans of the shutdown squad variety were convinced of the same, and equally certain the those rushing forth (part of the infamous 47 percent, they imagined, hooked on dependency) would become addicted to free health care, making it impossible to ever get rid of it.
But what we have so far are scraps of information suggesting practically no one signed up. Where is all that demand? Liberals have been arguing that, granted the rollout is a mess, but it’s nothing that time, billions more and a fleet of contractors cannot fix. Conservatives, meanwhile, have reveled in the software meltdowns, while becoming ever more convinced they must delay the individual mandate. But what if people ignore the individual mandate and won’t buy the insurance offered?
Well in that case, a legion of Geek Squad technicians will not fix the problem and Republicans don’t need to bother delaying something that is being universally ignored. It might just be that there is a rather serious design flaw.
Remember why liberals always wanted a single-payer plan. In addition to the nationalization of healthcare (eliminating all those nasty profit-makers) they warned that exchanges would be too complicated, the subsidies would be insufficient and, after Chief Justice John Roberts unilaterally amended the statutory scheme, that governors would not expand Medicaid, leaving a mass of working poor who still couldn’t afford insurance. That may have been exactly right. Then consider the assumption that young healthy people could be forced to overpay and overbuy for health insurance they did not want. “If you build it they will come” was good advice for an Iowa farmer, but maybe it was a faulty foundation on which to build a health-care system.
This is not a matter of people not knowing about the exchanges or the subsidies. A young healthy person can make a rational choice that he’d rather buy a car, risk a fine and, just has he always has, self-insure. As we have written before, those under the poverty level and not eligible for either Medicaid or exchange subsidies simply can’t afford Obamacare. And even those above the poverty line who do qualify for some subsidies may decide they can’t afford the insurance or want to spend their money on something else. Darn people — it’s like they have a mind of their own.
I don’t mean to suggest that Obamacare enrollment will inevitably be minuscule. Outreach efforts and computer fixes may raise the number of those enrolled substantially before the enrollment period ends. But it may be that far fewer people enroll than either supporters or opponents imagined. Will the administration at that point lift the mandate out of necessity, or at least delay it? Otherwise it is going to be fining millions and millions of Americans.
And then there is the matter of health care, not to be confused with health insurance coverage. An Oregon study suggested expanded Medicaid doesn’t lead improved health-care outcomes. If that is true, how can the government hope to herd people into the exchanges? And what is the justification for doing so?
In short, the shutdown squad made a critical political assumption based on scant data. Perhaps the case for delaying or repealing the mandate gets stronger with time. Maybe the plan, as its opponents said all along, really doesn’t make insurance more affordable and universally available. This is one reason among many to keep the focus on the plan’s shortcomings and to track the health outcomes. The shutdown squad’s assumption suggests that they were political hotheads, acting mostly out of self-interest, not devout conservatives (who understand government’s limitations).
If after all this only a few million people (say even 10 million) sign up by year’s end, and/or enrollees’ health-care outcomes are no better, then there will be a really strong case be made for finding a cheaper, less onerous and less economically harmful alternative for getting insurance for those who want it. To this end, rather than seeking to do the impossible, Republicans would spend their time more wisely on finding that alternative.