February 3 2014
An interesting statistic: according to a McKinsey & Co survey, only 11 percent of the new ObamaCare enrollees are people who were previously uninsured.
It appears that people who, for whatever reason, were uninsured before ObamaCare came along remain uninsured, even now that they supposedly have more choice in the matter. What gives?
After all, one of the key selling points for ObamaCare was that the uninsured would at last be able to have health insurance. The architects of the health system anticipated that they would gladly sign up for ObamaCare.
In a terrific piece in the Wall Street Journal, Michael Barone explains that real people don’t always act the way progressive planners in Washington, D.C., and academia expect them to.
But the apparent discrepancies between what policy makers expected and how many of the intended beneficiaries of ObamaCare seem to be behaving reminds me of the divide described in Charles Murray's 2012 book "Coming Apart: The State of White America, 1960-2010." Mr. Murray, my colleague at the American Enterprise Institute, documents the sharp differences in behavior between the upper (in education and income) 20% and the bottom 30% of white Americans.
The upper group has low rates of divorce and single parenthood and high rates of what Harvard political scientist Robert Putnam calls social connectedness. They belong to voluntary associations and churches; they vote and follow public-policy debates. They tend to be connected, engaged and conscientious. The lower (income and education) group has high rates of divorce and single parenthood and low rates of social connectedness. They tend to be disconnected and disengaged, and sometimes heedless. It should not be surprising that they may not respond to the same health-care mandates, incentives, and nudges that policy makers and others in the upper group do.
Policy makers, according to Barone, often say that universal health care works for Scandinavia, overlooking the fact that the U.S., with its diversity and disunity, is not Scandinavia.
It furthermore seems that some of the uninsured have weighed ObamaCare and found it, by their lights, wanting:
One reason may be that ObamaCare requires policies to cover not just the expenses of catastrophic illness—the sort of thing auto and home insurance policies cover—but routine medical expenses and procedures that many individuals will not need.
To that extent ObamaCare policies are not insurance but prepayment of routine expenses. Apparently many of the uninsured aren't interested in prepaying for health insurance any more than they are interested in prepaying their credit cards.
ObamaCare cuts against this grain. The trouble that has resulted—from the architects' apparent failures to anticipate the behavior of fellow citizens who don't share their approach to the world, and the architects' determination to impose their mores, such as contraception coverage, on a multicultural nation—is a lesson to national policy makers, conservative as well as liberal. Govern lightly if you want to govern this culturally diverse nation well.