(Bloomberg View) — Politicians — Republicans as well as Democrats — can learn a lot from the short history of health care reform. The lesson is: Get the policy right and improve the world. But don’t expect it to help your party.
Jonathan Cohn has a fascinating essay in the American Prospect exploring why the public mostly ignores the successes of some policies, while failures are big news. So, for example, the panic over Ebola last summer gave way to indifference once the disease was under control. Similarly, the botched initial rollout of the Patient Protection and Affordable Care Act (ACA) exchanges generated far greater coverage than the subsequent string of Obamacare successes.
Cohn borrows from political scientist Suzanne Mettler’s idea of the “submerged state,” referring to how certain programs — such as the mortgage-interest deduction or the earned income tax credit — are relatively invisible to those who benefit from them. Obamacare qualifies: There is no physical ACA card analogous to a Social Security card, among other things, and the words “Affordable Care Act” or “Obamacare” occur nowhere when people sign up for a plan on the exchanges.
Noting the contrast, Cohn concludes, “It would help a lot to design programs that help people visibly and directly, so no one has any doubt where the credit belongs.”
It’s a nice thought, but it isn’t a solution. After all, Medicare wasn’t “submerged” at all. Yes, it became popular — but it didn’t do much for Lyndon Johnson, Hubert Humphrey or others.