Obamacare and the Post Hoc Ergo Propter Hoc Problem

Since Obamacare as we know it could be subjected to some wrenching changes as soon as this Thursday, it’s a good time to take stock of its relative popularity. And the big trend, as noted by Mark Blumenthal and Jonathan Cohn at HuffPost, is no trend at all:

While the popularity of “Obamacare” has fluctuated a bit in the five-plus years since it became law, the amazing thing is how little public opinion has changed. Roughly speaking, a little more than 40 percent of Americans approve of the law, while around 50 percent disapprove — though the precise numbers vary a bit from survey to survey. The public doesn’t support repealing the law, as Republicans would prefer, and at least some people disapprove of the Affordable Care Act because they like the idea of it but wish it went further. But Americans have not wholeheartedly embraced the law, as its proponents have long hoped.

Blumenthal and Cohn go on to evaluate, using data from the Kaiser Family Foundation, the various reasons for the law’s image remaining mildly negative, with the most important being that people totally unaffected by the law who are Republicans really hate it because every single clue they’ve been given about it from Republican leaders and conservative media has been negative. But the hostility of Republicans and GOP-leaners has not been matched by enthusiasm from Democrats and their leaners:

Powerful as it is, the continuing partisan divide cannot tell the entire story. If it did, then the health care law would have a net positive rating, since more Americans identify or lean Democratic than Republican. When Kaiser researchers — again, at HuffPost’s request — tallied more than 8,000 interviews they’d conducted over the course of the year they found that intensity of opinion is much stronger among Republicans than Democrats and that Republicans are more likely to rate the law unfavorably than Democrats are to rate it favorably.

So what’s the mystery factor? The best guess is that people are holding the law responsible for all of the problems of the health care system — including those like rising deductibles, narrowing hospital networks, or even long waits at the doctor’s office that most experts believe have little or nothing to do with the law itself….

Maybe the single best example of this is the reaction to rising costs that polls have detected, especially among those largely unaffected by the changes to insurance mandated by the ACA. In the March Kaiser tracking survey, just over a third of Americans with employer-sponsored insurance reported that the new law had “directly hurt” (24 percent) their families. Why? On a follow-up question, most respondents — including 30 percent of all Republicans, 15 percent of independents and 6 percent of Democrats — said it was because the law “increased your health care or health insurance costs.”

But insurance premiums go up every year. That was true before the ACA became law and it remains true after. And since the law’s enactment they’ve actually risen more slowly than before. The historically low inflation is actually one of the most remarkable developments in health care today. And while economists debate over what role, if any, the health care law has played in this progress, there’s no compelling evidence that the law has made employer insurance premiums — the premiums most people see — rise more quickly.

Similarly, out-of-pocket costs really are rising and they are rising more quickly than wages, which is a big reason why people feel their impact. The law’s critics frequently complain about rising deductibles, as if the law were responsible for them — citing, among other things, a recent Commonwealth Fund report on the increases in out-of-pocket costs for consumers. But as Sara Collins, a vice-president of the Fund and co-author of that study, told HuffPost, “the trend in higher deductibles began well before the Affordable Care Act… the trend is entirely separate from the Affordable Care Act.” In fact, for people buying coverage on their own, the law sets limits on out-of-pocket expenses that insurers can charge — something that many plans lacked before.

This is known in logic as the “post hoc ergo propter hoc” (after this therefore because of this) fallacy, which is extraordinarily common and the source of all sorts of superstitions and mistaken impressions. And it’s not a terribly surprising problem when you consider the combination of hype (positive and negative) and complexity surrounding the Affordable Care Act.

By enacting such sweeping legislation, Obama and his allies tied their law to everything that happens in health care — good and bad and in between. And by largely avoiding changes that affect most Americans, they gave most people little reason to doubt the cues they get from the news and their partisan leaders.

The “questionable cause” fallacy is also, of course, a problem for Obama in other areas, too, notably the blame he has assumed for economic conditions he inherited, whose persistence, moreover, owes a great deal to Republican obstruction.

As for Obamacare, we can only hope Americans who blame the law for all the “preexisting conditions” in the health care system don’t find out otherwise because its benefits have been abruptly taken away by the U.S. Supreme Court.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.