The GOP Effect: not understanding Obamacare

Paul Krugman had a good op-ed about a month ago about the wonk gap on the right, “the G.O.P.’s near-complete lack of expertise on anything substantive.” Conservatism embraces an echo chamber atmosphere because it’s warm and fuzzy, and by that I mean it’s very comforting to surround yourself with sources that tell you what you want to hear.

Whenever things like this come up, I remember the excellent post that Julian Sanchez wrote on the right suffering from epistemic closure. It’s must-read and ever more relevant by the day.

It explains the GOP’s denial of election polling in 2012 and climate science generally, their lack of awareness of overwhelming support for things like universal background checks on gun purchases, their repeated problem with economics, and many other things.

You don’t find academics and scientists advising the GOP on climate change, you find businessmen and corporate lobbyists, because those are ideological allies. Academics have long been denounced as liberal elitists by the right and kept on the outside of their media sphere. Unfortunately for conservatives, academia happens to be where science comes from, and you can’t exclude one without excluding the other.

A few days after that op-ed, Krugman linked the wonk gap to the GOP’s Obamacare obsession and the possibility of their shutting down the government and/or causing America to default on its debt. This was nearly three weeks ago, back when I was giving the odds of a shutdown at less than one percent (whoops).

The justification that Republican aides were giving almost a month ago for delaying the individual mandate was that if Obama is going to delay the employer mandate, let’s delay other chunks of it too, if we can’t defund or repeal it.

As Krugman explained, that’s the wonk gap in full effect. The employer mandate was a disincentive for businesses to discontinue their health insurance coverage for no other reason than to increase profits. It should be one of the ACA provisions that Republicans support, because it’s the only thing keeping every business in the country from kicking their employees off their insurance plans and onto the exchanges where coverage might not be as good or affordable.

That’s a concern that Republicans have expressed since the ACA’s inception in 2010, and the employer mandate is supposed to prevent it. Yet their problem isn’t that a good provision was delayed, it’s that it wasn’t nuked along with everything else.

But that’s all the employer mandate does. It doesn’t provide significant funding for the exchange subsidies and it’s only a one-year delay, so it’s not like millions of businesses are going to purge their employer coverage for 12 months and then bring it right back next year to comply with the law and avoid the fine.

Businesses will still have to comply with the mandate next year and there is no significant downside to delaying it.

The individual mandate is another story. The mandate floods the private insurance market with healthy people in order to offset what otherwise would be skyrocketing premiums from the parts of the ACA that improve coverage by banning pre-existing condition discrimination. If you keep the extremely popular pre-existing condition provision but delay the mandate, you could very well send some of these insurance companies into bankruptcy, and premiums on the exchanges everywhere would explode.

Democrats didn’t pass the mandate for fun — it’s harmed them politically for four years and will continue to for years more — and Republicans didn’t invent it to amuse themselves. It’s the primary cost containment feature of Obamacare. Without it, you can’t have all the other stuff that people really like, not without sending premiums through the roof.

And I mean really through the roof. New York bans pre-existing condition discrimination already and has premiums above $1,000 per month. The Obamacare mandate is bringing that number down to the $300 range on the exchanges (before subsidies!) because that’s its sole purpose. If you delay the individual mandate and not the entire health care law, you’d be turning all of America into New York.

I had to explain to someone on Facebook about two days ago why the employer mandate could be delayed but not the individual mandate. I don’t expect very many people to know this stuff, it’s not necessary in order to know that the ACA will help you get affordable insurance that’s probably of higher quality than what you have right now.

But if even the Republican Party doesn’t understand it, how do they have any business talking about health care reform, much less trying insanely hard to make huge changes to it?

Someone asked me a few days ago why the GOP hated the Affordable Care Act, and I listed some of the reasons that I think explain it. But it never occurred to me that some of them may simply not understand it. Now it’s clear that either they don’t know, or they don’t care.

There are good reasons to oppose what the GOP is trying to do right now that have nothing to do with supporting the ACA. Delaying the mandate without also delaying the rest of the law would cause catastrophic damage to the insurance market. It’d also force millions of people to wait another year before they could get comprehensive affordable insurance. Yet it wouldn’t stop the law and we’d just have to go through this again next year.

Because the GOP tends to view things through superficial filters while blocking important outside sources of information, they just don’t understand that all the damage to the economy they predict from a smooth roll out of the ACA would actually come from delaying the mandate while leaving the rest of the law alone.

Flat out repealing the law would be better than delaying the mandate. It’d screw over about 40 million people over the next couple of decades, but it wouldn’t destroy the health care insurance market and destroy thousands of jobs.

Speaking of recession, has anyone read or written about the economic effects of the federal government furloughing 800,000 people? Even at the absolute worst of the Lesser Depression, monthly job losses didn’t exceed more than 750,000 to 850,000 jobs per month. I have a very hard time believing that suddenly having 800,000 federal employees laid off won’t damage the economy in some way.

With job growth probably averaging 130,000 to 150,000 per month this year, a sudden drop in 800,000 jobs should be scaring the hell out of everyone right now.

* * *

* The Washington Post editorial board blames only the GOP for the shutdown and demands they re-open the government. I don’t know who is on that board, but the op-ed page is edited by Fred Hiatt and regularly features posts by former Bush administration officials, current Republican politicians, and various conservative voices. If you wanted to find defense of Bush administration war crimes — torture — the WaPo op-ed page has been the place to go. This isn’t exactly the pages of the New York Times saying this.

* Former WaPo White House correspondent Dan Froomkin is firing shots at top tier media outlets for painting the shutdown as a dispute where “both sides” are to blame. False equivalency is the second most destructive practice of the mainstream media behind uncritical repetition and amplification of government claims.

* Between two government programs (Medicare, Medicaid) and the private insurance market, costs over the past decade have increased dramatically for two of them, while one has remained roughly flat the entire time — and it wasn’t the private market.

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