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Wednesday, October 16, 2013


Anthony Tsontakis has offered an interesting and thoughtful comment on my September 20th blog post:  "Why Does the Right Hate Obamacare?"  [Every so often Brian Leiter links to this site and for a day or two my site visits are off the charts.  I assume that Mr. [Dr.?] Tsontakis was directed to that relatively old post by Leiter's recent link.]  Here is the entire comment:

"Robert, I would be curious to hear what you might think of a counter-hypothesis formulated along these lines--one that does not make reference to racism to explain the hysteria. Here is an outline of the counter-hypothesis (very roughly formulated): The hysteria can be explained by a fundamental philosophical disagreement between, say, Republicans and Democrats, or the political right and the political left. On this theory, three things would be relevant about the ACA: 1) It effectuates a large-scale redistribution of wealth; 2) It effectuates a large-scale intervention by the government into the economy; and 3) It rearranges social relations on a fairly massive scale. I think what I mean by (1) and (2) is fairly straightforward. What I mean by (3) is that the ACA rearranges relations between individuals and state governments, individuals and the federal government, individuals and employers, individuals and health insurance companies, employers and state and federal governments, and between the state and federal governments themselves (and perhaps more). I think (1), (2), and (3) are fair descriptions of at least some of the major things that the ACA does, speaking, of course, in very broad and general terms. If that is right, then I would think it natural for people ideologically disposed to the right-wing of the political spectrum to be vehemently opposed to the ACA, because the ACA violates philosophical principles that are profoundly important, if not outright fundamental, to the political right."

Before I offer a response, let me make one thing quite clear.  My knowledge of the beliefs and sentiments of those on the right is based entirely on things I have read or have seen on television.  I have never had a conversation with a committed right-wing opponent of the Affordable Care Act, nor have I even, to the best of my knowledge, met one.  You would be quite correct in inferring that I live in a left-wing bubble [called Chapel Hill -- before that, I lived in a left-wing bubble called Amherst, MA, and before that I lived in the right wing bubbles called Morningside Heights, Hyde Park, and Cambridge.]   If this strikes you as disqualifying my from having an opinion, you are free to ignore the rest of this post.

Anthony Tsontakis states as fact three things about the Affordable Care Act.  I have my doubts about the truth of his claims, but for purposes of this response I shall assume that he is correct about all three.  I do this because my post sought to explain not the principled opposition of conservatives to the ACA, if in fact there really exists such principled opposition, but rather the intense -- in my view hysterical -- hatred that those on the right voice for the ACA and for the person principally associated with it, Barack Obama.  It is that intense animosity that I sought to anatomize.

First things first.  The central features of the ACA entered public discourse in America as a set of conservative Republican proposals put forward by the right-wing Heritage Foundation as alternatives to the single-payer model of health care reform advanced by the centrist Democrats of the Clinton Administration.  The principal aim of the Heritage Foundation thinkers was to preserve the private insurance core of the American health care model, despite the fact that this reliance on private insurance has driven American health care costs far above those in other mature industrial capitalist national economies.  These much higher costs impose a significant drag on the competitiveness of the transnational sector of American capitalism, a consideration that weighs heavily with conservative defenders of American capitalism.  The most controversial element of the Heritage Foundation proposals -- what is now called the Individual Mandate -- was dictated by a well-known and universally acknowledged fact about all insurance schemes, which is that they can be made affordable only if the population covered includes those less likely, as well as those more likely, to file claims.

The model proposed by conservatives received one trial prior to the passage of the ACA -- a health care system reform enacted into law in Massachusetts by a [then] moderate Republican governor, Mitt Romney.  During the 2008 presidential campaign, liberal and left-wing Democrats argued vehemently for a single-payer reform, rejecting as insufficiently redistributive and inadequately progressive the Heritage Foundation/Mitt Romney model.   After his election, President Obama made a major and ultimately successful political effort to enact a comprehensive reform of America's health care system.  Despite controlling both houses of Congress, Democrats were quite incapable of overcoming Republican opposition to a single-payer reform, and were forced to settle [by the skin of their teeth!] for the conservative Heritage Foundation plan pioneered by Romney in Massachusetts.  One of the compromises forced on the Democrats as a means of holding the support of "blue dog" Democrats and winning the crucial support of a tiny handful of moderate Republicans was a postponement of implementation of several of the most controversial features of the ACA until after the 2012 elections.

In light of this well-known and quite uncontroversial history, I find it unlikely, to say the least, that the explanation of the present right-wing opposition to the ACA is that, in Anthony Tsontakis' words, it "violates philosophical principles that are profoundly important, if not outright fundamental, to the political right."  The core ideas of the ACA did not violate those principles in the late '90s, when those ideas were advanced by the political right, and I am quite unaware of any deep, far-reaching change in the philosophical principles of the political right in the intervening time.

A secondary support of my thesis is the evidence that even the most intense opponents of the ACA are found, repeatedly, to support particular elements of that program when those elements are presented to them without any association to the ACA.  I have in mind the covering of children on their parents' health insurance until the age of 26, the elimination of pre-existing medical conditions as a reason for refusing private health insurance, the lifting of lifetime caps on benefits, and so forth.

There is even some fragmentary polling data that suggest that the real object of the antipathy of many opponents of the ACA is simply the name "Obama."  When asked which they prefer, the Affordable Care Act or Obamacare, a number of people say that they like the ACA and hate Obamacare.

Finally, I will mention again the striking fact that occasioned my original post, namely the element of hysterical hyperbole characterizing the utterances of the opponents of the ACA.  Now, as I indicated when I began this response, my knowledge of that hyperbole is entirely secondary.  It is certainly possible that the media, with their well-known penchant for what we might call shock-journalism, have deliberately featured the wildest and most irrational opposition to the ACA, thereby concealing from view the measured, reasoned, principled views characteristic of the great majority of opponents.  Maybe so.  But I doubt it.

So, for all these reasons, I doubt that Anthony Tsontakis is correct.  If he is wrong and I am right, then we are confronted with the question to which my original post was addressed:  Whence the extraordinary, hysterical animus?  My explanation may of course be wrong, but I think my question is pertinent, and calls for factors that are much psychological and ideological as they are factual or philosophical.



Jim Westrich said...

I probably cannot give this post enough attention at this time but I would offer a few thoughts on the details on the implementation of Romney's Health Insurance plan in Massachusetts.

Romney's approach was always very pragmatic and while there were ideological limits to what could be done (for example, one particularly astute health economist who worked at Medicaid pointed out that the state could simply expand Medicaid and the insurance package would be better and cost the state less money but that was definitely not politically acceptable)--Romney moved to get all the major players in line (there is an interesting bit of money thrown at the Mass Hospital Association that was probably unnecessary but Romney got their strong support).

Democrats in Mass. wanted Universal Health insurance but were never that sure of how (by my count there was at best 40% support in the state house for single payer and a lot of that support was soft) and Romney had their support. Kennedy and his staff got everything Romney needed federally and they actually worked quite well together as this was also a very Kennedy type effort.

The kicker was always how do they get universal coverage without raising any obvious revenue. Part of this answer came from the fact the Massachusetts at the time was the only state in the country to offer free hospital care to the uninsured (their "uncompensated care pool" which based hospital payments on charges). Romney had already cut the total money available to the Uncompensated Care Pool but his people knew that this was politically "free money". Also, they did tax the insurance companies (they got more business but had a to pay a small tax to get it). Finally, the relatively health uninsured consumers paid more in premiums than necessary as well (this was about getting universal coverage and efficiency, at least initially, was less important.

The plan had to be universal as Massachusetts already paid the health costs of the uninsured through the Uncompensated Care Pool as well as "presumptive eligibility" for Medicaid (Mass Medicaid allows sick people to get immediate care using Medicaid "presuming" they are eligible--this is great for hospitals and the sick--but it means you can be poor and officially uninsured without the negative consequences in the rest of the country.

This is all to say that while Affordable Care Act is as Prof Wolff describes a political compromise there were pragmatic mechanisms that Romney had available to minimize the political fight and ideological conflict (no obvious taxes, premiums, and changes to health delivery). There are lots of little details, but Prof. Wolff is absolutely right that in spirit they are politically nearly identical.

I do not understand the animus from the right toward the affordable care act and I understand less the rejection by Republican governors of expanded Medicaid (I understand it as pure political sabotage and spite towards the low-wage working poor which the Affordable Care Act does a poor job of helping).

Jerry Fresia said...

Mr. Tsontakis's term "rearranges" is questionable, to say the least. For example, the "right's" broad and relentless attack on women (attacks Plan Parenthood and abortion clinics, not to mention on Gays as well) - at the same time that it supports the Pentagon - does not "rearrange" so much as re-enforces the relationship of the individual to an intrusive federal government. One could add NSA surveillance, which provides Tea Baggers with an impeachable offense that they seem to be seeking, but yet ignore.

Moreover, Mr. Tsontakis' argument is ahistorical. I urge readers to take a look at Ishmael Reed's recent post ( in which he nicely locates the anti-Obama hysteria in an undiminished racism that extends back to the Confederacy, for historical context.

Again, as I have mentioned in the commentary section previously, I have not seen any study which suggests that the ACA is redistributive (top down) - certainly not in a way as to rial Tea Baggers who both embrace Medicare and Social Security.

Chris said...

1) It effectuates a large-scale redistribution of wealth; 2) It effectuates a large-scale intervention by the government into the economy; and 3) It rearranges social relations on a fairly massive scale.

Response to 1): These claims by the right always bother me. At least from a Marxian perspective, one is instantly aware that wealth redistribution is the MO of capitalism. Even if I drop the Marxian point of view, capital is always in motion, always circulating, always responded to supply/demand factors outside its control, etc. There is no stable wealth process in America that is suddenly perverted by outside redistribution.

But let's press further, let's say we agree that the state telling us how to spend our money is morally wrong and should be rejected on principle. It still wouldn't follow that private insurance is not wealth redistribution. After all, when I was a member of BCBS (for one year after HS), all my insurance payments were going to people I didn't know, for coverage I had no say on. Not to mention my premiums were responding to market demands I had no control over, and the costs I had to pay when I saw the doctor were inflated due to the coverage of non-insured emergency patients. So 1 is inherently wrong for many reasons.

Respond to 2): This one really peeves me. In order for this particular economy to exist - i.e., capitalism - the state must intervene constantly, or at least exist with the threat of intervention, to maintain capitalist order. There has never been, never will be, and never can be, a stateless capitalist marketplace. If you want capitalism, you want a state, that's armed, intervening. So a principled state against state intervention is a principled stance in favor of anarchism, and against capitalism.

3) Not in any qualitative sense. A real radical social intervention was Oliver Cromwell executing the notion of divine sovereignty. This bill is just a quantitative change in how often we see some of these people.

Chris said...

p.s. I say all this as a staunch opponent of the Affordable Care Act (which really is hurting my impoverished wallet), someone who loathed ever machination Obama made in getting the bill passed, and a huge proponent of single payer system or Cuban healthcare system.

Chris said...

Wolff, I completely reject the idea that the democrats were pro single payer. I watched those 2008 debates, and the ONLY people supporting that system were Dennis Kucinish, and Ralph Nader.

When it came time to actually generate a bill, Obama's must left position was the public option. He never once brought up single payer, and the logs that have come out about his backroom negotiations before presenting the bill suggest he never had any interest in it.

At the time Obama first proposed his bill, code pink, and various groups were going around congress filming democrats and asking them their thoughts on single payer (I watched all this every morning on democracy now), and almost EVERY SINGLE DEMOCRAT remained reticent about such a bill. They simply ignored the cameras. A FEW, like Barney Frank, would say "sure sounds great in theory, we'll never have the votes, so no." When pressed by the interviewers that in fact the democrats controlled congress and could have the votes, more reticence followed.

Anthony Tsontakis said...

Robert, thank you for this response, and thank you to those who left their thoughts in the comments section. (Apologies to the person who was peeved by one of my three points!).

I was genuinely curious for Robert's thoughts, so I will not respond in substance here (plus, I do not have the time--a likely excuse, I know!). I will say that I understand the distinction Robert is trying to draw between principled opposition and outright hysteria. I agree the question is pertinent, and that it calls for an explanation that is psychological and ideological.

A few things about myself: I am not a Dr., or a PhD., but am a practicing attorney. I try to keep up as much as possible with the academic literature on the subjects that interest me, which generally include philosophy, history, politics, and law. And yes, I was directed to the original post from Brian Leiter's blog. Thank you again for the thoughtful response.

Chris said...

Anthony, Sorry if my comments came across as aggressive. I wasn't upset by your position, I just tend to sound polemical.