Blaming Ourselves for the Obamacare Lies

Americans want to be told that they can have their health care cake and eat it too.

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This Oct. 7, 2013 photo shows sesame kale salad in Concord, N.H. This dish is simple, healthy and would go well on the Thanksgiving table.

Imagine that you are looking to hire a personal trainer. Two candidates are interviewing for the position. The first candidate visits your home and outlines in great detail the things you will have to do in order to lose 20 pounds: eat less; drink less; sweat more. Words like "kale" and "spandex" creep repeatedly into the conversation.

The second candidate is more upbeat and positive. She explains that you will lose weight by cutting the "inefficiencies" out of your diet, though the details remain vague. The extra exercise you need will come from having more sex. Again, the logistics are not thoroughly fleshed out. Yes, you will need to eat more vegetables, but she promises that they can be sautéed in bacon.

After hearing both pitches, you eagerly hire the second candidate. And then, over the course of the next year, you gain 17 pounds.

That vignette is the most important thing you need to know in order to understand American politics. President Obama isn't the only one who tells us what we want to hear. He's just really good at it.

In fact, Obama's recent misrepresentation — that those of us who like our insurance can keep it — is neither the first nor the most serious intellectually dishonest statement with regard to health care reform.

[See a collection of political cartoons on Obamacare.]

In the Democratic primary, then Senator Obama declared that his health care plan, unlike Hilary Clinton's, would not require anyone to buy insurance. No personal mandate. That was nonsense, not merely because of what came later, but because it made no sense at the time. No health care plan could achieve the three things Obama was promising: 1) Guaranteed coverage; 2) No more punishingly high premiums for those with preexisting conditions; 3) No insurance mandate.

Why? Well, think about the logic here. If healthy people are not required to buy insurance, unhealthy people cannot be denied coverage and everyone pays the same rates, then the only logical time to buy insurance is after you become seriously ill. And if only seriously ill people buy insurance, the system would collapse.

Senator Obama and his aides must have recognized this. If not, he and his advisers have an insufficient grasp of economics to be overhauling health care.

But as I heap scorn on President Obama, let's pivot for a moment and recognize two other sad facts.

[See a collection of political cartoons on the economy.]

First, the Republicans are just as bad. What is the Republican plan for fixing American health care? The system is broken, with or without the Affordable Care Act, as this shocking figure from the OECD illustrates.

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If "repealing Obamacare" is step one of the Republican health care plan, then we need to hear a lot more about step two.

But more important, shame on us. The voting public seems unwilling or incapable of recognizing that addressing real policy challenges inevitably requires serious tradeoffs. You don't lose weight by eating more ice cream.

Yes, we can curtail our carbon emissions ... by raising the cost of polluting activities, like driving, heating our homes, and manufacturing things.

Yes, we can make Social Security solvent for the long run ... by cutting benefits, raising the retirement age or increasing the payroll tax.

Yes, we can simplify the tax code ... by cutting "loopholes" that many of us benefit from, such as the home mortgage interest deduction.

But how do we treat politicians who embrace ideas like creating a carbon tax, raising the retirement age for Social Security or limiting the home mortgage interest deduction? Not well.

[Check out our editorial cartoons on President Obama.]

I always ask my students a seemingly simple question on the first day of class: Why is it that every sensible policy solution (defined as delivering significant net social benefits in the long run) is so politically unpopular? The answer is obvious only after the fact: Because if it these policies were popular, we would have done them already. Any policy equivalent of "low-hanging fruit" was plucked by the Truman administration. Or Ford. Or Carter. Or Reagan.

We are the ones who are going to have to face the policy treadmill. If we continue to elect politicians who promise otherwise, and punish those with the courage to talk about kale and spandex, then shame on us.

PS: If you don't believe that America refuses to get on the treadmill literally, check out these shocking obesity data from the OECD. This will, by the way, make our health care problems much, much worse in the long run.

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