Saturday, October 19, 2013


The sunny view of Obamacare is that once it's an established, familiar part of our lives, Americans will enthusiastically embrace it and find it impossible to imagine going back to a time before we had it. (That's also, for right-wingers, the gloomy view of Obamacare.) Repealing it will be as unthinkable as repealing Social Security or Medicare.

But I don't believe that. I think Obamacare is going to be like legal abortion: it's going to be something right-wingers never stop picking away at, and always regard as a long-term grievance.

The New York Times reports:
... in Virginia's capital, conservative activists are pursuing a hardball campaign as they chart an alternative path to undoing "Obamacare" -- through the states.

One leading target is Emmett W. Hanger Jr., a Republican state senator from the deeply conservative Shenandoah Valley, who prides himself on "going against the grain." As chairman of a commission weighing one of the thorniest issues in Virginia politics, whether to expand Medicaid under Mr. Obama's Affordable Care Act, he is feeling heat from the Republican right.

His openness to expansion has aroused the ire of Americans for Prosperity, the conservative advocacy group backed by the billionaire industrialist brothers Charles and David Koch. Dressed in emerald green T-shirts bearing the slogan "Economic Freedom in Action!" its members are waging what the senator calls "an attempt to intimidate me" in Richmond and at home.

They have phoned his constituents, distributed leaflets and knocked on 2,000 doors in his rural district. When the Republican town committee met Monday night in Mr. Hanger's home county, Augusta, Americans for Prosperity was there....

"This has been one of those trench warfare kind of efforts for a year now, and I think it is one of those hidden stories of the whole fight against Obamacare," said Tim Phillips, president of Americans for Prosperity. "It's not flashy; it's just in a whole bunch of state capitals and in the districts of a whole lot of state legislators, but it's such a crucial aspect of the overall long-term effort to roll back Obamacare."

The state-by-state strategy represents a split from the course pursued by Heritage Action for America and its sister organization, Heritage Foundation....
It "represents a split" only in the sense that the state-by-state fight for fetal heartbeat laws and mandatory transvaginal ultrasounds "represents a split" from the fight for a national Human Life Amendment -- yes, one is incremental and the other isn't, one is state-based and the other is national, but they're part of the same struggle.

The Supreme Court's ruling that states can opt out of Medicaid expansion has become a fundamental weakness of Obamacare; another weakness is the optional nature of state-run health health exchanges. Both give governors and state legislators too much power over implementation -- and we know from the gun control and gay marriage fights that it's relatively easy to punish state legislators and elected state judges who deviate from conservative correctness on hot-button issues.

But a bigger weakness is the fact that everyone isn't an Obamacare beneficiary, which means it's easy for the right to say that Obamacare is a liberal plot to tax "us" to give a benefit to "them." (Yes, obviously any one of "us" could lose employer-based health coverage at any time and become one of "them," but right-wingers never think that way.)

I know, I know -- we're not getting single payer anytime soon. That's why I support Obamacare. But I'm not under the illusion that the right will ever accept it or stop fighting it, any more than the right ever stops fighting abortion rights or gun control or the teaching of evolution in public schools. I really believe we'll battle over Obamacare forever. If the haters can't kill it, they'll never stop trying of chip pieces off it.


Greg said...

Best overall assessment of That Darn Obamacare I've yet seen. The fact that America hasn't been able to enact something as fundamentally pragmatic as single payer reflects a deeper problem with the national character, one that Obamacare, trying to half-ass and compromise its way into keeping hope for progress alive, isn't likely to make a difference with. At least not by itself.

aimai said...

No. I'm sorry to disagree with you but, no. I mean, I agree that it will be a permanent source of grievance, like Social Security and Medicare and Medicaid are. But unlike abortion, which only a small part of a despised population gets, health insurance and seeing a doctor when you need to without going bankrupt is going to be fully integrated into everyone's life in a very short order.

One of the chief reasons that anti abortion rights activism has been so durable is quite straightforward: location, location, location. Once abortions were forced out of hospitals and therapeutic locations they could be picketed and otherwise unemployed church based nutcases could spend happy days doing so. Modern health care delivery is private and distributed--there is no one to picket and no one to shame and therefore no one will be discouraged from using Obamacare because of public outcry.

Of course there will still be people who go on it and bitch about it--but they will never take active steps to end the program, they will just tinker around the edges, because they personally benefit too much. It will become the same kind of third rail that SS and Medicare became. People will make a lot of money and get votes promising to do something to rein in the excesses or bring the program under control. But in the end they will do nothing because all their voters depend on it.

aimai said...

I'd like to point out that Texas made a huge fuss and is now trying to put its uninsured onto Obamacare. Kentucky has already gone over to the dark side. Arizona is going. The medicaid thing was a setback but what makes sense as a posture at the national level never makes sense at the local level. As long as the people principally served by Obamacare were imagined to be (say) wetbacks, non voters, and minorities there were always going to be the same local politicians who disapproved of giving them anything. That was certainly Arizona and Texas's first impulse. But over time when there are no other rising voters to coax to the polls local politicians, even republican ones, will want to have something to offer their voters as a bribe rather than as mere spite. Things are going to shift pretty fast, actually. If the health care crisis weren't so huge and it didn't involve so many people (because of pre-existing conditions and job loss) this wouldn't be the case, but it is. Even the angry white old people are related to tons of people who are white and who don't have health care. They are going to end up backing the exchanges even if, in theory, they hate people on medicaid.

White Hat said...

Precisely when did the right stop trying to nick away at Social Security and Medicare? Ryan's half-baked budget proposal did both - and it earned him a "smart guy" rep and a shot at being VP. It even raised its nasty little head again last week, along with a number of other separate "demands" to cut both programs.

Besides, there are two major differences between the ACA and legal abortion. Governors on a budget clearly see that states have a direct, immediate and obvious $$$ incentive to participate in the ACA, because it permits them to reduce or eliminate state-funded services. The money's there, just quit saying no. Even Rick Perry sees that.

While states can achieve similar budget savings from family planning vs. state support for unwanted children, that's a more distant connection, apparently not within the grasp of morons.

The other big difference is the Christian element. Lord knows, even they can't find scripture opposing health. But opposition to abortion/punishment for sex is the biggest single bone Republicans can throw to the Christian Right. Everything else they demand is either too completely stupid (creationism) or plainly unconstitutional (institutionalized prayer).

No, the ACA is an "entitlement" program like SS and Medicare, and GOP opposition to it is a) part of its ongoing campaign to punish the poor and promote income disparity, and b) just another item in its main agenda: prevent Democratic wins.

In very short order, cutting or eliminating the ACA will be impossible. Not because of its effectiveness or popularity or any rational criteria, but because eliminating it would COST STATE GOVERNMENTS MONEY. And GOP governors especially can't have that.

Steve M. said...

As long as the people principally served by Obamacare were imagined to be (say) wetbacks, non voters, and minorities there were always going to be the same local politicians who disapproved of giving them anything.

The right-wing base will always see Obamacare this way, just as the right-wing base sees unemployment and disability insurance this way now. Facts don't matter.

Precisely when did the right stop trying to nick away at Social Security and Medicare?

They haven't, but they have to disguise what they're doing with the Orwellian phrase Frank Luntz cooked up for them, "preserve and strengthen."

Victor said...

Yes, they'll try to chip away at it FOREVER!!!

But carrying some form of PPACA health care policy isn't as obvious as being 'with child.'

People will be able to rail against Obamacare and still be beneficiaries - and it won't be as obvious as the person railing against abortion one day, and then coming into the clinic in disguise, for themselves, or smuggling in some loved one.

Steve M. said...

I'd like to point out that Texas made a huge fuss and is now trying to put its uninsured onto Obamacare. Kentucky has already gone over to the dark side. Arizona is going.

Texas is doing this because it allows the state to shutter a state program. Kentucky is doing it because it has a Democratic governor. In Arizona, Jan Brewer is not a down-the-line wingnut, and her state is somewhat purple.

Yes, states that take a hard line against Obamacare are harming themselves financially. That's not stopping a lot of them. And there'll be lots and lots of creative ways for O'care to be undermined, at the state and federal level, in the years to come.

aimai said...

Right, but there will be tons of reasons why individual states are going to sign on, over time. Because it makes fiscal sense. I don't mean they will stop demagoguing Obamacare, but their demogoguery isn't going to make much sense to voters who are, in fact, signed up for the health care.

The Koch brothers top secret plan hinges on persuading college students to drink beer and try to find affordable healthcare elsewhere. Demographically this is a dead end for them: rising college students will be used to being on their parents health care until they are 26. Fewer and fewer people will see going naked as at all rational when signing up is easy and affordable. Women will be signing up in droves because their twenties are a time when they are fertile and require health care services. The Koch brothers are pinning their hopes on the ressentiment of a vanishingly small segment of a segment of the society to destroy Obamacare and that isn't going to work.

Pretty soon everyone in the country is going to be on precisely the same healthcare--private insurance--just some people are going to have bought it through the exchanges and some people will have it purchased for them by their employers. There just isn't going to be a neat way to attack it.

Examinator said...

Aimai and Steve
I think aimai on the money.
The problem with the conservatism it that it's based on conserving the status quo in money and therefore power. At the voter mind set is generally speaking based on emotional (instinctual) manipulation (fear etc.) by those who stand to lose (various current businesses and rich share holders etc).
e.g. on another site the spouse of Cintas employee (a hospital specialist laundry/services corp.) states they have already put out a warning “with stats” about the consequences of Obama care.

Given the possible impact on the share price of such a corp wide document one can only deduce they are: either using Obama care as cover for profit maximization layoffs etc;
Political manipulating their employees and shareholders the against possible fragmentation of their core business.
i.e. if more patients (including the 10 million odd new ones) start to utilise local doctors practices there will be a lessening of laundry/ sterilising from hospitals. Consequently servicing more smaller clients would cost more and as such mean either a cut in profitability or facilitate the rise of local smaller service providers, loss of market share again decrease in profit.
What the conservative voter doesn't realise is that either way there will be more jobs just not only into the coffers of Cintas, the pockets of the executives and their share holders.
It is hard to reconcile 10 million extra health consumers equalling anything other than a job and distribution of more profits (growth) benefit to the country.

Aimai, I now live in Australia and the most noted difference in attitude to “Medicare” (in their terms here) is one of amazement at the US's machinations over universal heath.If one was inclined to describe the Aussies politically, they are conservative, in that they don't like rapid or extreme changes. But once they have a benefit like Medicare, any party/politician that tried get rid of or restrict it would be doomed. It would motivate the population at large to organize a mass political lynching of the politicians/ party that tried.
The conservatives try to tinker with it but they are mindful of when they tried to change the industrial system and were well politically reamed. The point is they've had it singe 1970's so I'm told and the country hasn't gone broke … even the private health insurance companies.

Steve M. said...

Wait -- you think Cintas making a big stink about business losses from Obamacare is a sign that business prefers Obamacare? Wow, that's some serious eleven-dimensional chess.

Examinator said...

I'm confused now !
I was saying that businesses use changes that *may * effect their business as cover for restructuring that they would have done any way. It is a PR tactic … e.g. “it wasn't us who wanted to do these unpopular changes but Obama Care forced it on us. BLAME it on them ”.

They would be encouraging their staff (30000 of them), their share holders to oppose Obama Care. Because it is bad for THEIR Business.

They would have a policy to put the worst face possible of the outcomes of Obama Care on their businesses too, to influence them oppose it too. It's called building a fence around your business to minimise client leakage.

The i.e. was to give you Cintas's probable reasoning reasoning
The point I was making was amongst the possible reasons they are making a fuss is because they fear OBAMA CARE may lead to the fragmentation of their market... which has two probabilities: The first the need to employ more sales staff and more smaller clients(this would lead to less profitability).
The second would lead to more smaller local organisations eating into their market share.(less profit)

The next paragraph was acknowledgement that the conservative (and TP) voter would see Obama care from this perspective as it confirms their mind set. I then comment that they wouldn't see the greater benefit as are obvious when one picks the Cintas reasoning apart as I did.
I chose Cintas because it represents the business objections to Obama care clearly for what they are BLATANT SELF INTEREST.
The reality is that businesses and the average voter including the cone isn't interested in the benefits to the country i.e. more net jobs/profit or jobs/profit elsewhere just their own. This is hyper self interest is hardly Uber Patriotic as the conservative demographics see themselves!