Meadville Tribune

Our Health

December 18, 2013

Five myths about the future of Obamacare

(Continued)

2. New policies create a new politics.

It is certainly true that policies can become durable by building supportive clienteles. MIT political scientist Andrea Campbell has shown how Social Security transformed senior citizens into the most active participatory age group in American politics. As we argue in our recent essay in Perspectives on Politics, however, new programs do not create a new politics automatically. To generate a clientele that actively defends its benefits, programs must not only deliver resources, they must change the way recipient groups perceive their social identities and their relationship to the program. If voters don't see a program as helping them, it is less likely they will storm the barricades when opponents try to take it away. It is remains unclear just how much of a clientele the ACA will produce. The ACA is a far more redistributive reform than many other social programs. Some Americans will be losers. Moreover, as political scientist Jonathan Oberlander points out, "unlike Medicare and Social Security, Obamacare does not have a well-defined population of beneficiaries, and its benefits are diffuse." The ACA "treats different groups of Americans in different ways and different times," making it harder to mobilize public support. The ACA can build a constituency, but it may do so less effectively than the most durable entitlement programs.

3. "Deck stacking" can stop policies from being unraveled.

A major threat to a policy is that the coalition that enacted it may be replaced by a future coalition that opposes it. One solution is to "stack the deck" by creating institutions that make it harder to damage the program in the future. Vanderbilt's David Lewis has shown that policymakers can make legislation more durable by giving independent commissions control over policy implementation. Yet in the fragmented American political system, in which lobbyists can nearly always find a friendly institutional venue, there are limits to deck stacking. The ACA, for example, created the Independent Payment Advisory Board to require the secretary of Health and Human Services to implement its recommendations unless Congress passes an alternative plan to reduce Medicare costs. Yet the IPAB has not yet been launched due to opposition from industry groups and many members of Congress.

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