As Republicans hash out their differences on healthcare, an ABC/Washington Post poll found that 37 percent of Americans favor repealing and replacing Obamacare, compared with 61 percent who say it should be "kept and fixed."
Conservative activist Phil Kerpen took some issue with the framing of the results, tweeting that the idea of fixing the system or of repealing and replacing Obamacare are just "different names for what GOP is trying to do." But the poll results are consistent with other polling suggesting Americans warming up a bit to Obamacare whenever the repeal talk heats up.
Republicans in many ways are confronting what the late free-market economist Milton Friedman described as the "tyranny of the status quo" back in the 1980s, when the Reagan administration was struggling to translate the rhetoric of shrinking government into reality.
"The strongest political influence on a legislative body is exercised by special-interest groups of citizens who favor a government program that confers substantial benefits on them, while imposing small costs on a large number of their fellow citizens," Friedman wrote, along with his wife Rose. "Each such group is a corner of an iron triangle of beneficiaries, politicians, and bureaucrats."
Though many remain passionately opposed to the program, Obamacare provides benefits to those with subsidized health insurance, businesses have spent years adapting to its existence, and many others have learned to live with it. Repealing it will inevitably disrupt the health arrangements of millions of people, even if it provides relief to millions of others.
For decades, status quo bias was the enemy of Democratic efforts to impose national healthcare. Public fear of disruption of their own healthcare arrangements is what killed the Clinton healthcare push in 1993 and 1994. Having the benefit of hindsight, President Obama sought to overcome this status quo bias – from his initial decision not to pursue single-payer healthcare to his infamous lie that everybody could keep their insurance and doctors if they liked them.
Republicans still talk of their desire to repeal and replace Obamacare, but they haven't found the collective will to scrap the elements of Obamacare that provide benefits, even though those same elements contribute to the parts of Obamacare that are unpopular (rising premiums, reduced choices of plans, and fewer options of doctors and hospitals).
Centrists who previously pointed fingers at the the conservative House Freedom Caucus for being intransigent, are now objecting to a compromise that would preserve Obamacare's regulations nationally, just because it would give states the option of applying for a waiver from some of those regulations.
Conservatives have argued that removing requirements that all insurance policies cover a certain set of mandated benefits, and limiting how much insurers can charge older and sicker enrollees, is one way to drive down premiums on the broader population and increase the range of choices available to consumers. Centrists criticize the higher premiums under Obamacare, but they don't want to get rid of the regulations, fearing the backlash from undermining guarantees for people with pre-existing conditions. They have offered no alternative ideas to lower premiums while keeping Obamacare's regulatory infrastructure intact. In fact, when I asked Rep. Charlie Dent, R-Pa., chairman of the centrist Tuesday Group, how he would prefer to lower premiums given that he wants to keep the regulations in place, responded, "That's the $64,000 question."
It's clear now why conservative activists fought so hard against Republican governors such as Ohio's John Kasich who were pushing for states to sign up for Obamacare's $1 trillion expansion of Medicaid, even as those same governors touted their opposition to Obamacare. Now those governors have become an obstacle to repeal, lobbying for Medicaid money, and those Republicans opposed to the bill have predominantly come from Medicaid expansion states.
Beyond the difficulty Republicans have had with generating the support to deliver on their seven-year promise to repeal Obamacare, they have been unwilling to embrace bolder solutions to replace Obamacare, such as those that would move the nation beyond the antiquated employer-based insurance system and instead give individuals more control of their health care dollars.
Seven years of rhetoric on repealing replacing Obamacare is meeting the reality of the tyranny of the status quo.