How big an issue is Obamacare?

Is Obamacare (more properly called ACA) a major issue in this election? Is it a major issue for most folks?

It's hard to tell. The comment boards are still stuffed with vociferous supporters and detractors. Conservatives are still predicting a train wreck, which was supposed to materialize for two years now. Liberals are counting up the successes, and recounting how conservatives' worst predictions haven't panned out.

It's still too early to call ACA a success. We don't know the effect of the health systems or what the costs will be in terms of the federal budget within a few years. The Medicare program costs almost double its projected expense: the program needs a yearly infusion of over 45% of its expenditure beyond the payroll tax that are collected.

IT'S BIG!

ACA really should be a big issue. It's a major piece of legislation affecting a lot of medical care and health insurance, particularly in terms of cost. However, if it's not a big issue, it's because the GOP don't know how to talk rationally about it, and don't know how to criticize it rationally. Most of all, they don't know how to replace it.

The usual conservative meme is that Obamacare is a takeover of the healthcare system, which is about 17% of our economy, maybe higher. This is an exaggeration, of course. You don't have to check in with some government department to see your doctor, as you would have to, say, register a car. The government has a monopoly on car registration, but nothing like that with doctors. Most of the other conservative claims are also wild exaggerations.

This irrational talk can't help too much with swing voters, so I wonder why the GOP does it. Perhaps a party really has to energize the base and the haters in the run-up to an election. Maybe it's just habitual for the GOP, who never stopped hating on the Clintons. But it definitely doesn't help with voters who are trying to make rational choices. On the other hand, that group of voters (the rational swing voters) may be so tiny that it doesn't matter. That's a really sad thought.

Repeal and ... um ... um

I'm not sure which is worse: the irrational critique or that the GOP haven't settled on a replacement. They should have had one for the 2012 election. Maybe they lost partly because of that gap in their agenda. I certainly wasn't going to vote for them with a gaping hole like that.

This vagueness was a problem for them in 2012, and continues to be a problem. Dems can run on the status quo--"don't let the GOP undo what we've accomplished." The GOP can't run on that, but they haven't figured out what they will run on, other than irrational exaggerations about how bad the status quo is. What a stupid party the GOP is, and what a shame for voters who deserve a choice.

Sure, that passes the reality test.

Image: thelastgreatstand.com

Short: Let go of that fetish

I talked about political fetishes earlier, and labeled Obamacare as a fetish to the Tea Party. Making the GOP vote for higher taxes is a fetish for the left. Ezra Klein at the Washington Post doesn't use the same term, but he's on the same page. His advice to the Dems: don't push for tax increases and you will get so much more from the GOP:

"...they should see their leverage clearly: Republicans badly want entitlement cuts, but they don’t want them enough to trade for taxes. They badly want to replace sequestration, but not enough to trade for taxes. And they badly want tax reform -- but, again, not enough to trade for higher taxes."

I saw this with the sequester too. Now I'm not a partisan who wants the Dems to extract more concessions through wily negotiations, but I'm happy to see someone else being practical and clear-headed in their view of the negotiation process. 

Image: tribalartasian.com

Extra. You could also think of these fetishes as 'taking a trophy' or capturing your opponents' flag. It is the sweet victory of humiliating your opponent. It's not a smart goal, but sometimes we really want to do it.

Missing: Real fiscal negotiations

. . . chasing a fetish instead

For some unknown reason, the GOP decided to forego fiscal negotiations in the run-up to the appropriations for next year, and focus only on defunding Obamacare. They turned Obamacare into a fetish and focused all their energies on it.

Obamacare is certainly not the only political fetish. In fact, politics is full of fetishes. Each party tries to raise up their fetishes and burn those of their opponents. Here are a few fetishes off the top of my head: assault weapons ban, balanced budget amendment, green jobs, DADT, "real Americans," ...

Actually, I ran out of fetishes sooner than I would have thought. To me, a fetish is a practically useless but politically powerful piece of policy or jargon. In actuality, it doesn't matter, but politicians latch onto it for political grandstanding. Obamacare doesn't really fit this definition, since it will have real consequences, but it has been turned into a fetish because politicians have inflated its symbolism to a great degree.

Negotiate or bust

So, back to the point. Instead of doing some horse-trading on funding this and that, cutting hither and thither, the GOP has wasted months on Obamacare. They did manage to pass a bill in the House cutting 5% from the food stamp budget, but that's it. Maybe someone in the GOP (not you, Rand Paul) remembered to make up a prioritized list of other cuts, and will whip it out after the Obamacare offensive is defeated. If not, the GOP will yet again be caught out with no negotiation strategy. This happened in December '11, Feb '12, Dec '12, and March '13. When will the GOP learn?

The Dems, of course, like spending as much as they can get away with, so they aren't taking up the slack and suggesting their own cuts. Nancy Pelosi says there's nothing more to cut, but also that the Dems will work with the GOP to make government more efficient and end duplication of services. Her negotiation strategy is "you go first." This cynical strategy isn't good for the country at all, but those hopeless Republicans don't have anything better.

I hope we can get back to the situation in 2011 when the Tea Party was pushing for some real cuts, and they weren't going to back down. That was a realistic goal and it worked.

Right now they're engaged in a folly, and they seem to be throwing more energy at it than they had in 2011. Why are they flushing away their power on an unattainable goal? The only answer I have is that they don't know and don't care what is achievable and what isn't.

Perhaps we were damned lucky that they focused on budget cuts in 2011 and not Obamacare. Maybe it was just dumb luck, and not any wisdom at all. If the Tea Party chooses its goal irrationally, they are going to be a bull in a china shop until they're shot down. On the basis of 2013 vs. 2011, I'm not ready yet to declare the Tea Party totally irrational, but that's definitely on the list of possible explanations.

So, to the Tea Party, please go back to demanding some fiscal restraint. Show that your 2011 rational choice wasn't an aberration.

Image: washingtonpost.com

Extras. The food stamp cut mentioned above was 5% of a $80 billion budget that's doubled since 2008. The stimulus increased the grants, but that is also due to end, which may mean the total cuts are larger, perhaps on the order of 10%. The Dems are screaming about "food insecurity," which means one person in a household skipped as few as one meal a month due to food availability. Fetish, anyone?

Bernstein: GOP is "post-policy"--they have no proposals. Josh Barro complains about the lack of rational healthcare reform ideas among the GOP. Yeah, I noticed that.