Obamacare: Make It Clear People Are Still Free to Choose

It’s well acknowledged that the White House has faced some obstacles in selling the Affordable Care Act to the wider public. What’s curious about the public perception of the law is that folks tend to prefer the particular provisions of the bill when presented as standalone policies — it is only when the packaging of “health care reform” is mentioned that people begin to speak in broad strokes about their disapproval, the overreach of government, and the coming zombie apocalypse of health care costs in America.

Proponents of the bill won two key victories — one in the conversation, the other in the courts — that seemed to herald a sea change in public perception. The first possible turning point was when advocates of the Affordable Care Act re-appropriated the moniker “Obamacare” with the rhetorical turn shown below: 


The second possible turning point took place nearly a year ago, when Chief Justice John Roberts of the Supreme Court upheld the constitutionality of the bill’s individual mandate in his writing of the majority opinion.

However, the law still faces unyielding opposition inside and outside the Beltway. Even after the Supreme Court victory, House Republicans attempted for the 32nd time to repeal the bill in Congress. The public still seems similarly uninformed, misinformed, or disapproving of the bill.

With the introduction of Obamacare’s health insurance exchanges later this year, the White House is continuing to fund outreach efforts. The most notable of these might be the four-step plan of the Centers for Medicare and Medicaid Services (CMS). As CMS Administrator Marilyn Tavenner explained to Senator Baucus during her nomination hearing:

CMS has been busy implementing a four-step plan for outreach. The Preparation phase began last year and continues until Open Enrollment begins. This includes conducting consumer research and building infrastructure for our customer service channels like the call center and website. The Education phase began in January 2013 and goes through June. It includes building awareness of the new Health Insurance Marketplace, by creating content for consumers, and training personnel and partners. The Anticipation — or "Get Ready" — phase of work begins this summer. It includes additional details about program operations (like web and call center) as they come online, as well as training for navigators and other certified assisters who will help consumers through the enrollment process. The Enrollment phase will run from October 2013 to March 2014. It includes a major launch effort that will engage all media channels, as well as provide new customer service channels and in-person assistance.

Outreach efforts of this kind (and included in these are private outreach efforts by non-official advocates of the law) assume that the challenge is to connect the unpopular package of Obamacare to the popularity of its provisions. In so doing, outreach efforts tend to perpetuate the liberal trope of if-they-only-knew-better-they-would-agree-with-us. While some outreach of this kind will be effective, the problem is not one that will be solved by connecting the bill to its popular provisions ex post facto, after the negative sentiment has been established. Instead, advocates of the health care law should try to determine where the antipathy is rooted.

To understand the origin of alarm at Obamacare, one needs to go back to the scene of the bill’s passage. The picture painted for many Americans by the preachy narration of conservative pundits and legislators was one of overzealous and power-drunk Democrats in control of both houses of Congress and the presidency, colluding to impose a bill of unjust burden on the American people while they had the reins of power. In this picture, while various damning policy provisions were “exposed” to reveal the dystopian vision of Obamacare, the real attack on on freedom was the gesture of passing the bill. This is why vitriol is directed at the bill in name, its policies only a proxy for that original sin.

But what is wrong with this particular imposition? At the core of Obamacare is the requirement is that every American obtain health insurance. This doesn’t appear to be terribly injurious to our basic freedoms, but it’s painted as such. In this sense, what opposition to the insurance mandate suggests is that any encroachment of freedoms can be assailed as an affront to the underlying virtues achieved through decision-making.

Corey Robin, author of The Reactionary Mind, claims that the “moral secret of capitalism, its existential fundament, is not that we are free to choose but that we are forced to choose.” He explains that Ludwig von Mises and Carl Menger, two thinkers in the pantheon of conservatism, see the choices that arise from liberty as tests of what we value. Even with a choice as seemingly unnecessary as whether one should get health insurance (you should), it is the choice itself that generates character.

In this sense, it may be worthwhile for the Obama administration to emphasize the place of choice in the Affordable Care Act. The mandate to obtain insurance is not a mandate to obtain any particular plan. That is the very point of insurance exchanges. Further still, states can choose to opt out of the reform if they can provide like coverage for their citizens. With the implementation of Obamacare full speed ahead, the way to a naysayer’s heart does not travel through appeals to inevitability. And it may not be enough to extol the benefits of the bill. Outreach to an opponent of Obamacare, if it is possible, will require speaking to him or her in the language of choices. 

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Rajiv Narayan

I'm currently a contributing curator at Upworthy and a grad student at the University of Oxford, where I study Medical Anthropology. In the last year I was an Associate at the healthcare information firm Close Concerns, where I covered research, drug, and policy developments in obesity and public health. Before that I was a Research Assistant at Social Policy Research Associates. And not too long before that I was finishing my undergraduate studies at the University of California, Davis, where I was very privileged to be a Regents Scholar and graduate Phi Beta Kappa with highest honors in a self-designed major. In college I was a 2010 Young People For fellow and the Senior Fellow for Health Policy at the Roosevelt Institute Campus Network. At various points over the last 4 years I've worked on an urban farm in Milwaukee, interned at the California State Assembly, and taught classes on the Social Theory of Eating Disorders at UC Davis. On the academic side, I researched obesity legislation in Argentina, food stamps in California, the racial dynamics of obesity policy in Southern States, and fat acceptance activism in California.

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