Megan McArdle: ObamaCare Unlikely to Survive Political Realities As Is

The closer we get towards 2014, the more I am skeptical of the idea that this program is going to get more popular as it goes forward…. What people are expecting seems to be a very expensive form of insurance (no gatekeepers or restrictions) on the cheap.  What they’re going to get is cheap insurance that they will be forced to buy.  Moreover, a significant number of workers are going to be dropped from their employer plans and dumped on the exchanges.  An even more significant number of workers are going to be shunted onto Medicaid….

Naturally, this is going to create immense political pressure to ease the restrictions.  It’s common to hear progressives say that this is a good plan, if only Republicans don’t screw it up.  We’ll leave aside the wisdom of passing a health care plan which requires one of the two major political parties to somehow vanish.  In the case of Medicaid reimbursements and the exchange restrictions, Democrats are going to be at least as subject to political pressure to revise the program in the direction of making it more expensive….   It is looking more and more as if PPACA as passed is simply not politically (or practically) stable.  I think Democrats were counting on having more years in control to tweak it.  That was a very dangerous gamble, especially considering how badly it did in the polls.

Full piece in The Atlantic. Compare to my own analysis of the politics of health reform.

Comments (6)

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  1. Nancy says:

    I agree totally. The Democrats made a bad gamble — on a very bad bill.

  2. Vicki says:

    I agree with Nancy. I think the Democrats are in trouble.

  3. Devon Herrick says:

    The problem is that the law has passed and will likely not be repealed in its entirety. Rather, special interests will lobby to remove specific sections while other groups will lobby to retain specific sections. It will be harder to organize a unified assault on the bill. Take the individual mandate, for example. It is unpopular so it could easily go. But the insurance regulations that necessitated the mandates (i.e. guaranteed issue / community rating) are relatively popular may not go. The result would be catastrophic for the insurance industry.

  4. Stephen C. says:

    I think John Goodman nailed this in his health Alert about the politics of health reform a few weeks back.

  5. steve says:

    Most of the parts of the bill, other than the mandate poll quite well. The Democrats gamble may not work so well. We shall see. The Republicans also gambled. They tried to make it as bad a bill as possible and have refused to work towards improving it, going for repeal. That may also fail.


  6. Art says:

    No ObamaCare won’t provide cheaper care; it will provide much less care, since demand will increase greatly causing increasing pressure for higher quality and service.

    The promised words’ affordable, high quality and access come to mind; but with an inelastic supply of providers and an elastic and more demanding number of consumers with no care qualifications, it just doesn’t foot. You can’t get 5 pounds into a 3 pound paper bag without breaking it. Does anyone think the 40 million or so will get care, or the same amount of “boomers” and “seniors” will receive less care and perhaps will see the start of NICE in America. NICE is what Europe uses to deny costly care to government program patients [usually the elderly] in an openly regulated manner to be fair. Without transparent safeguards these would be “death panels”.

    Who will set the rules here?