(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.
In fact, however popular individual programs are, public opinion about government in general (which appears to be Cohn’s main concern) doesn’t work the way most people think it does. Instead of rewarding liberals (or conservatives) when their policies succeed and punishing them for failures, Americans simply turn against whichever party is in the White House. That “thermostat” reaction meant voters became more liberal during the presidencies of both George W. Bush and the much more successful Ronald Reagan. On the other side, people became more conservative during the administrations of Barack Obama, Bill Clinton and Lyndon Johnson.
This suggests you make people appreciate government only by putting conservative Republicans in office — an outcome that sort of defeats the purpose.
Yet a program can be kept safe even if it isn’t popular. Yes, Social Security and Medicare are visible and popular and resistant to cuts. But the mortgage-interest deduction and the pre-Obamacare health care subsidies, while relatively invisible, can’t easily be dislodged because voters who don’t realize they benefit from them would miss them if they suddenly disappeared.
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The lesson of the unpopular Affordable Care Act, then, is that liberals should stop worrying so much about whether their programs have high public-approval ratings, or how to make government as a whole popular. All a popular program accomplishes for those inclined to hate government is to spawn a “keep your government hands off my Medicare” attitude. That is: People who hate government either based on ideology or short-term “thermostat” reactions to liberal presidents won’t be deterred even if they like what government is doing.
Instead, the most liberals can hope for is to pass and carry out programs that solve or at least ameliorate the problems they care about. But these programs won’t create more liberals. Likewise, conservatives can carry out policies they believe in or eliminate those they think make problems worse. But that isn’t how they will produce more conservatives.