Last week marked the 14th anniversary of the signing of the Affordable Care Act. As a general matter, people don’t have elaborate observances of 14th anniversaries, but Democrats did everything they could to elevate the topic through media events and statements to highlight its ongoing role in the presidential campaign.
What was more interesting was the messaging response from Republicans: absolutely nothing. Donald Trump binge-posted his way through the occasion without pausing to include any mention of it among the dozens of social-media messages he frantically emitted. Fellow Republicans were likewise silent, and none of the conservative media I closely follow engaged with the topic.
It’s standard procedure for conservative media to ignore stories that hurt the party. Fox News routinely buries any news that counters the Republicans’ preferred narratives, even news that accidentally breaks itself (like Mike Pence declaring he wouldn’t endorse Trump). That practice has the obvious benefit of helping Republicans win day-to-day messaging wars, an advantage Democrats frequently envy. But there’s also a cost to burying inconvenient questions: They don’t have to figure out the answer.
Trump attempted to repeal Obamacare in his first term and committed what most observers deemed to be a gaffe by blurting out his desire to try again in a second term. Even though Trump backtracked in public, the temptation would be very strong. High interest rates will probably create pressure to reduce the budget deficit, and the GOP’s theological opposition to tax hikes and practical reluctance to reduce spending on retirement programs will leave few other options.
But what will they do about it if they gain control of the government in the 2024 elections? Repeal Obamacare? Cut it? Ignore it? I don’t know for sure, and I’m confident they don’t know, either.
This ambiguity hurt Republicans the last time they had a governing majority. The reason for the ambiguity is that Republicans were split between hard-core ideologues who have strongly held but unpopular preferences and partisans who don’t know anything about health-care policy but just hate Obama. The ideologues believe access to health care is a privilege to be earned, not a right everybody should enjoy. They believe people who can’t afford the unsubsidized, unregulated cost of health insurance should earn more money or lead a healthier lifestyle. If they’re too poor or too sick to pay for their own health care, it’s their problem, and other people shouldn’t have to pay more to cover them. This belief is almost totally unique to the American right, and even in the United States, it’s unpopular enough that conservatives tend not to make it a public-facing message.
Instead, Republicans rallied their base with generalized anti-government, anti-Obama messaging. This strategy allowed them to rail against real (or, more often, imagined) shortcomings in the law’s operation without spelling out the trade-offs Republicans would impose instead. They could get Republicans excited about attacking big government or owning the libs by reversing Barack Obama’s biggest accomplishment without either endorsing or refuting the right-wing belief that people who can’t afford health insurance on their own should just suffer.
The ambiguity worked well enough through Trump’s first election. Trump had campaigned on a promise to repeal Obamacare, but he also promised to replace it with a new plan that would give everybody better insurance for less money without making anybody pay for it. This was obviously impossible.
They could have finessed the lie by passing some cosmetic tweaks, rebranding the new system as “Trumpcare,” and taking credit for it, which is how Trump handled his promise to “repeal” NAFTA. Alternatively, they could have bitten the bullet and thrown millions of people off their insurance. Since they had no consensus, they were unable to do either one and paid a huge price in public opinion for attempting and failing to do the latter.
The whole project was based on a delusion that Obamacare was a “train wreck” and some conservative alternative could supply a better-designed system that didn’t have horrific costs. The paradox of propaganda is that when you set out to brainwash others, you end up brainwashing yourself.
Conservatives spent years attacking Obamacare for a series of mostly imagined design flaws. They claimed it would create death panels, or drive up health-care costs, or fail to reduce the number of uninsured people. None of these predictions came true. Indeed, the cost of health care has come in significantly lower than the law’s designers forecast.
This has been a recurring pattern in conservative thinking about social policy. Every new advance of the welfare state is met with hysterical doomsday predictions. When those predictions fail to come true, conservatives skip any self-examination and move on to their next doomsday predictions. Ronald Reagan warned that passing Medicare would create a socialist dystopia in which the government could order doctors where to live and America would resemble the Soviet Union. When Obamacare was introduced half a century later, conservatives brought up these warnings not as a cautionary tale about conservative hysteria, but as a prescient warning about what the next health-care expansion would surely bring.
A healthy conservative movement would admit its analysis of Obamacare had been utterly mistaken and revise its thinking. Or, at least, conservatives could recommit themselves to the right-wing goal of throwing the poor and sick off their insurance and bear the cost of doing it. Health care accounts for more than one-sixth of the American economy. A serious party ought to have something to say about it. Instead, their plan, once again, is to ignore the issue and figure it out after they gain power.
