This week’s open enrollment for Obamacare once again made me wonder: How can conservatives be so convinced of the healthcare law’s failure when the opposite is demonstrably clear? Obamacare is far from perfect, but it’s in no way a “disaster,” a “catastrophe” or “imploding.”
In 2010, the year the Affordable Care Act was signed into law, nearly 50 million people in this country were uninsured. As of 2016, that number had dropped to about 29 million, according to the National Center for Health Statistics.
People with preexisting conditions could no longer be charged more or denied coverage by insurers. Young people could remain on their parents’ plans up to age 26.
Yet Republican politicians and voters remain determined to do away with Obamacare, regardless of the shortcomings of their proposed replacements.
A paper in the latest issue of the Journal of Consumer Research, published by Oxford University Press, sheds light on their thinking by observing that conservative consumers are prone to “right-wing authoritarianism” and “system justification motivation.”
Those are fancy ways of saying conservatives are more willing than liberals to accept what their leaders say as true and have little appetite for rocking the boat.
Kiju Jung, a lecturer at the University of Sydney Business School and coauthor of the paper, told me conservatives are basically more inclined “to believe in society’s institutions, and thus to avoid challenging these systems.”
“This underlying difference helps to explain why conservatives resist new consumer offerings that represent dramatic change — for example, Obamacare,” he said.
The paper is titled “Blue and Red Voices: Effects of Political Ideology on Consumers’ Complaining and Disputing Behavior.” Three of the four coauthors are based at the University of Sydney Business School and one is from the university’s School of Psychology.
The Australian academics delved into complaint databases run by America’s Consumer Financial Protection Bureau, National Highway Traffic Safety Administration and Federal Communications Commission. They inferred political leanings with county-level data from the 2012 U.S. presidential election.
According to the paper, research on right-wing authoritarianism “shows that conservatives are more likely than liberals to yield to authority figures.”
At the same time, it says, conservatives are more willing to “justify potential failings of the existing social system and its institutions.” Such system justification aims to legitimize the status quo, “seeing it as ‘good, fair, natural, desirable and even inevitable.’”
This reflects conservatives’ belief that people should act “in ways to preserve either societal orderliness or its illusion.”
Note that last bit: societal orderliness or its illusion.
That goes a long way in explaining why so many Republicans are willing to accept a party line that U.S. healthcare was much better before former President Obama tinkered with things, despite the Affordable Care Act’s obvious improvements.
“Obamacare is a total and complete disaster,” President Trump said at a campaign rally in February 2016.
He tweeted in March: "Obamacare is imploding. It is a disaster and 2017 will be the worst year yet, by far!”
In June he said that “we're going to come out with a real bill, not Obamacare. And the results are going to be fantastic … and everybody is going to be happy.”
Republicans never passed such a bill. In October, Trump resorted to an executive order slashing subsidies for Obamacare, which most experts said would, yes, cause the program to implode.
Marketers have long understood that political ideology can shape consumer behavior.
“Messages appealing to individuality were more effective for liberal than conservative consumers, while those appealing to a sense of duty to the group were more effective for conservative than liberal consumers,” the Australian researchers found.
Obviously there are pitfalls in generalizing people’s attitudes. So I contacted Joseph Antos, a resident scholar at the conservative American Enterprise Institute who focuses on health policy.
He laughed when I described the Australian study’s conclusions and said it was “quite comical” that conservatives would be characterized as having a knee-jerk aversion to change.
“Any normal human being is going to be concerned about changes where the impact is unclear,” Antos said. “Ordinary people don’t care about the Affordable Care Act. They care about their insurance and the cost of healthcare.”
Fair point. And, yes, premiums on the Obamacare exchanges have climbed much more than expected.
However, that’s not the disaster Trump makes it out to be. It’s primarily a factor of insurers failing to anticipate a surge in claims as millions obtained coverage, as well as a too-weak mandate that allowed healthier people to avoid buying insurance, thus raising costs for everyone else.
These are problems awaiting solutions from reasonable people capable of having grown-up discussions.
I find the Aussie researchers’ work reassuring. The dysfunction of our pre-Obamacare health system was so profound that it’s hard to imagine anyone thinking those were the good old days. Again: 50 million uninsured, coverage denied to people with preexisting conditions.
Not to mention annual and lifetime caps on insurance payouts, women paying more than men, premiums in the individual market rising by 10% annually, skimpy coverage for many plans, a very real fear of being uninsured if you lose your job.
If Republicans can build on Obamacare’s advances, they should do so — there’s certainly room for improvement. What we’ve gotten instead has been dozens of votes to repeal the law without a viable alternative to replace it.
The party’s most recent healthcare bill, known as Graham-Cassidy, would have slashed Medicaid spending by $1 trillion, stripped insurance from millions of people and eliminated consumer protections for many with preexisting conditions.
“Graham-Cassidy Bill is GREAT!” Trump said in a tweet.
As the Aussie researchers found, conservatives “act in ways to preserve either societal orderliness or its illusion.”