Five years after its passage, Obamacare stands as a monument to much that's wrong with American politics. But it also, increasingly, is evidence of much that's right with it, too.
First, the bad news. Obama isn't just as bitterly polarizing as ever — it's also as confusing as ever. The media has covered the law and its implementation more thoroughly than perhaps any other law in recent American history. But according to a national poll conducted by PerryUndem for Vox, only 18 percent of Americans say they know enough about what's in the Affordable Care Act. And it's not clear that more information would do much good: only 19 percent of Americans think what they hear in the news about Obamacare is even "mostly true."
Much of what Americans know about Obamacare is simply wrong. A plurality, for instance, think the law is costing more than originally estimated. Only 5 percent know it's actually costing quite a bit less:
The result is that opinions on the law are pretty much the same as the day it passed: 83 percent of Americans say their view of Obamacare hasn't shifted over the past five years.
But the good news is, well, really good. Obamacare's premiums are much cheaper than anyone expected, and a new study by the Kaiser Family Foundation shows most enrollees are happy with their health insurance, happy with the value they're getting for their money, and happy with their choice of doctors and hospitals:
In total, a new Rand study estimates that Obamacare has gotten 16.9 million people insured. And all this is happening amidst the most profound slowdown in national health-care costs in decades.
More information won't save American politics
Obamacare is an example of a depressing fact of American politics: more information doesn't change minds.
Social scientists have tested this again and again. The more information partisans get, the deeper their disagreements become. When it comes to politics, people reason backward from their conclusions. Politics makes smart people stupid.
Consider how much we've learned about Obamacare in the past five years — and how few elected officials have changed their minds about it. We know how many people it's covering and how much its premiums are costing and how badly Healthcare.gov was designed and how high the deductibles are and how narrow the networks are becoming and how happy people are with their insurance.
Yet no congressional Democrats have watched Obamacare's progression and turned against the law. No congressional Republicans have noticed the law covering tens of millions of people with cheaper-than-expected premiums and decided maybe it's not such a disaster after all.
If anything, the opposite has happened. In a last-ditch effort to wound Obamacare by wrecking it in Republican states, conservatives have begun developing a bizarro-Earth history of the law — one in which Congress built federal exchanges for the sole purpose of ruining insurance markets in recalcitrant states. Five years later, it is not just opinions on Obamacare's worth that have diverged. The two sides can't even agree on what the law says or the history of how it was passed.
Among these elites, the problem is not too little information, nor too little trust in the information. It is too much information that confirms their priors, and too much trust in arguments and "facts" that suit their ends. But the result is much the same. If Americans sometimes seem to disagree on Obamacare because they know too little, Washington's bitter divide is the result of knowing too much.
This is a good place to stop for a moment and be clear about my priors, though they are already quite obvious: I think the evidence is, at this point, overwhelmingly on the side of the law. Obamacare is nowhere near perfect, but it's doing pretty much what it said it would do, at a lower cost than anyone thought. The law can and should be improved, but the simple fact is that the federal government is covering millions of previously uninsured Americans and spending less on health care with Obamacare than it expected in 2010 to spend without Obamacare. That's remarkable.
Some readers might see my side of this argument as convincing. Some might see it as deluded. In some ways, that's the point. My counterparts and I are drowning in Obamacare data and are no closer to agreement than we were five years ago. More information is just giving both sides more ways to confirm what they already believe.
Washington can't reason. But it can govern.
The state of the Obamacare debate is depressing. But the state of the law is encouraging across pretty much every metric you can find.
Despite a terrible start — the mess that was Healthcare.gov will be used to scare public administration students for generations to come — the law is working pretty well.
The Congressional Budget Office estimates that Obamacare will cut the ranks of the uninsured by 17 million in 2015 — and will cost more than $100 billion less than originally thought. Enrollees are quite happy with their coverage. And, nationally, America's health-care spending is growing more slowly than it has since the 1960s — a trend Obamacare can't take full credit for, but that it hasn't interrupted and is likely helping along.
Obamacare's biggest problem is that the Supreme Court let states opt out of the Medicaid expansion — and dozens did.
But a few years in, a majority of states have signed up, and even the reddest locales are slowly but surely coming around. Right now, Kansas and Utah are thinking about joining Obamacare's Medicaid expansion even while Obama remains in office. It's a pretty safe bet that once Obama leaves, and some of the polarization around his signature law leaves with him, all or nearly all states will eventually participate in the law.
And this is, more broadly, the bright spot for American politics as a whole. Even as it is often irrational for elected officials to look at the facts and come to a conclusion that puts them at odds with their party, it is rational for them, when in power, to come to conclusions that will help them govern well.
This was evident even when the Democratic Party first passed and implemented Obamacare. The law was unpopular by the time it passed — and one reason was that Democrats had actually made it fiscally responsible legislation, adding hundreds of billions in spending cuts and tax increases. Healthcare.gov was a mess on the day it launched, but the White House fixed it quickly — even as some liberals downplayed the severity of technical problems, the Obama administration knew its legacy depended on the law actually working.
This is true across policies. Democrats may broadly support tax increases, but Democratic presidents worry about the distortionary effects of high taxes. Republicans may want to drown the government in a bathtub, but they know better than to get voters too wet. That isn't to say either party governs perfectly, or even always rationally. But governing has feedback loops that press releases don't. Parties that want to stay in power — and they all do – have an incentive to do a good job.
In that way, voters discipline the system even if they don't know much about individual policies, and even if they don't regularly update their opinions on how various laws are working. Most people aren't experts on politics, but they are experts on their lives and the lives of their loved ones. If the economy is tanking, or their health insurance is being yanked away, or their cousin was just wounded in an unnecessary war, they eventually punish the politicians they think responsible.
It's not a perfect system — sometimes elected officials end up paying for the sins of their predecessors, or can pass legislation where the bill will be sent to their successors — but it's better than we sometimes give it credit for.
For all the rhetoric, imagine what would happen to, say, President Jeb Bush if he sought to uproot Obamacare entirely. Tens of millions of Americans would lose their health insurance overnight. Any search for a coherent replacement would spark a brutal political war within the Republican Party. Republicans would suddenly be on the wrong end of the "if you like your health care, you can keep it" promise. Remember that for all the energy congressional Republicans spent in the 1990s trying to cut Medicare, Bush's brother, once in the White House, ended up massively expanding it. The incentives of governing are very different from the incentives of politicking.