At TNR, the very wise Jonathan Cohn has a listicle of five “rules” for talking about Obamacare in 2014, now that it’s more or less a reality. A couple of these rules are pretty straightforward if easy to forget: regular folk are going to be surprised by aspects of Obamacare that wonks have understood for years, so don’t be surprised by their surprise; and don’t let the anecdotes overwhelm your sense of the scale of things.
The “rule” that deals with the biggest problem, however, is this one:
RULE #5: CONSIDER THE REAL COUNTER-FACTUAL.
Health insurance premiums are going to rise next year. And lots of people are going to blame Obamacare. But insurance premiums rise every year. The real question—not just next year, but in the years to come—is whether they rise more quickly or more slowly than they would have if Obamacare had never become law.
And that’s true of other developments, as well. Before the Affordable Care Act took effect, employer-sponsored insurance was deteriorating and the number of people without coverage was rising. Employers and insurers were looking for new ways to cut costs—which in some cases meant asking beneficiaries to shoulder higher out-of-pocket costs or limiting them to smaller networks of doctors and hospitals. Obamacare won’t stop these trends. The question is whether it slows them down or somehow makes them less punishing to consumers.
Obamacare opponents, of course, will constantly take advantage of this confusion by attributing all the accumulated sins of the American health care system to the Affordable Care Act. And that brings up another communications problem that Jon’s five rules can’t do much about: the refusal of much of the political Right to come to grips with any empirical assessment of the ACA or of the health care system generally. If you read conservatives as much as I do, you know that for most of them it is axiomatic that Obamacare is already an abject failure, not to mention a radical experiment in socialized medicine and in wealth redistribution. The first contention is wildly premature, and the second and third are, well, just kinda dumb agitprop. But hewing to them is a sort of recognition signal among conservatives that they will be loathe to give up, and that makes rational discussion of the Affordable Care Act very hard.