As House Republicans revive a revamped Affordable Care Act replacement bill with more support from the libertarian wing of the Republican party, Republicans and Democrats have gone back-and-forth over the impact of the bill on people with pre-existing conditions.
As The New York Times noted in a recent review of each party’s claims, both have played fast and loose with their evaluations of the policy. Republicans have overstated the degree to which the bill protects those with pre-existing conditions, and Democrats have overstated the negative effect it might have on the same group.
Health insurance policy is notoriously complicated, and both liberal and conservative policy experts disagree on how to unravel a 50-year-old mess created by bureaucracy and bad bills.
But rather than acknowledge the complexity of the issue and each bill, from the ACA to its replacement, the two major parties will continue to do what they do best –– oversimplify the topic, deal in half-truths, and carefully manage political capital to bolster future political prospects. This is not an accidental byproduct of the American political system, but a core feature: the system incentivizes dishonesty, poorly-informed votes and short-sighted policy.
Economist Thomas Sowell has long argued that politics incentivizes short term thinking for political leaders. With healthcare, popular policies get politicians re-elected but have long term consequences that require still more policy to fix detrimental unintended consequences. Politically, that has made either fixing or replacing the ACA a tenuous game for both parties, even if both acknowledge flaws in the original plan.
It is not hard to estimate how much this political calculation weighed on the minds of 2010 Democrats fighting off Republican gains, or on Republicans now who face a potentially devastating blowback in 2018. This has put Republicans in a tough position vis-a-vis the market-oriented preferences of the House Freedom Caucus, whose proposals (policy merit aside) are not politically attractive to a country where most voters prefer heavy government involvement in the industry.
Because of this, a party that has traditionally paid lip service to small government principles has to publicly argue that the bill is strong in protections and regulations, even where the small government-focused House Freedom Caucus has intentionally removed or weakened them. In short, the way the core of the party wants to govern is no longer politically attractive.
The incentives for this complex balancing act of political popularity and policy impact are further bolstered by the distorted incentives associated with voting. After all, the play for popularity wouldn’t work without a response from voters, who have little incentive to be intimately informed about policy. As philosopher Jason Brennan notes, “In a major election or referendum, individual voters have no greater chance of making a difference than they do of winning Powerball. They have no incentive to be well informed.” Brennan argues that many voters lack the resources available to sharpen their knowledge of the complex fields at play in political debate, and most don’t even when the resources are available.
Accordingly, voters remain systematically misinformed about the things they’re voting on. Most voters - even those with strong opinions on the ACA or the American Health Care Act (AHCA) don't understand how health insurance works, how subsidies and regulations re-shape markets, or how even a small selection of the proposed changes will affect regular consumers. But we are expected to vote according to the analysis of politicians, expecting that they’ll do the legwork for us - even when they haven’t read the bills they will be voting on.
Because voters lack this incentive to be properly informed about policy issues, they play right into the mixed incentives on the part of politicians to both change policy and remain politically popular. The result is a feedback loop that maintains political power but can result in stubbornly bad policy.
The New York Times article mentioned above perfectly encapsulates this dilemma in the healthcare debate: both parties are misrepresenting their own policy initiatives, and those of their presumed opponents. Why would they do otherwise when voters lack the acumen to accurately diagnose such nuanced falsehoods and half-truths?
This may result in a series of bad bills, but what is more important is that the two parties have successfully managed their political capital. This isn’t an accident - it’s endemic in a system that - starting up with Obama - incentivizes dishonesty, disincentivizes high levels of voter knowledge, and sticks us all with bad bills that are hard to change and harder to remove.