In the wake of the Supreme Court ruling upholding the Affordable Care Act (a.k.a. "Obamacare"), NPR's "Talk of the Nation" held a seminar of sorts at the Aspen Institute's legendarily pretentious Ideas Festival. Someone in the audience asked NPR health policy correspondent Julie Rovner this question: "Today's decision is a positive decision for the estimated 50 million uninsured Americans. Who are the losers today?"
Rovner seemed to struggle to find losers. She came up with insurance companies that want the so-called individual mandate — now a punitive tax according to the Supreme Court — to be much more punitive. After thinking through her answer, she later added that another group of losers might be the citizens of states whose governors opt to not participate in the law's expansion of Medicaid.
So, Obamacare creates no losers except where it fails to tax people sufficiently and where GOP governors fail to accept the wisdom of the law. In short, the only thing wrong with Obamacare is that it isn't even more punitive, more mandatory and more intrusive.
It is an interesting perspective given that this is arguably the most controversial law in our lifetimes. It nearly sparked a constitutional crisis, largely caused the Democrats to lose their majority in the House and, despite herculean efforts by the president to "sell" the law (more than 50 speeches, formal statements and national addresses on it during his first year), it has never been popular with most Americans. And yet, according to Rovner, the law creates only winners if properly implemented. Why on earth are opponents so stupid?
For the record, there are losers under Obamacare. Here's a short list: 1) taxpayers who will carry the load of what the Congressional Budget Office says will be a $2-trillion price tag when the law is fully implemented; 2) the CBO also says it's likely that at least a few million workers will be pushed off their current insurance coverage, even though the president insists you can keep your existing insurance if you like it; 3) innumerable and unknowable numbers of sick people who will not be screened for various diseases because some bureaucrats' protocol says it's too expensive; 4) Roman Catholic and other religious institutions forced to violate their values; 5) a few million so-called freeloaders who don't want to buy health insurance for perfectly rational reasons.
Obamacare defenders have responses to these objections, and critics have responses to those responses. Still: Serious people do believe that the law creates — or just might create — losers.
I don't mean to pick on Rovner. Her views on Obamacare don't strike me as exceptional so much as typical — typical of a liberal Washington establishment that still seems incapable of grasping what the fuss is about.
Hence the Beltway fantasy that Obamacare's unpopularity reflects nothing more than a sales problem. Indeed, the new mantra is that the Supreme Court's decision has provided the White House a golden opportunity to "sell" a law that has been on the books for two years already.
Only a third of Americans fully supported the law when it was signed, according to a NYT/CBS poll, and today that number stands essentially unchanged. In fairness, a fifth of the law's opponents are left-wing voters who would prefer a single-payer system that doesn't involve incestuous collusion between government and big business. I don't support socialized medicine, but I can respect this sort of principled objection.
But why is the only legitimate opposition to the law one that creates "losers" in some actuarial or accounting sense? Even if I thought we could afford a vast new entitlement, I'd still be opposed to Obamacare.
Whether it's called a tax or a mandate, the federal government has never opted to compel citizens to purchase something as a condition of breathing while American. Obamacare represents a major advance for the old FDR vision of turning sovereign citizens into clients of the state. It empowers an army of Bloombergs to do what they think is for your own good and to redefine your rights as mere perks of the system.
I admit I have an old-fashioned conception of what our country is supposed to be about. And people like me are losers under Obamacare too.