Barone: How ObamaCare Misreads America

"The evidence is not all in," writes Michael Barone. "But it seems that Americans are not behaving as ObamaCare's architects—and many critics—expected." He notes three key assumptions embodied in the law that have proven to be mistakes:

• Everyone wants health insurance, and the uninsured will flock to buy it, especially if they qualify for a subsidy. It didn't happen. Moreover, recent polls show only 24% of the uninsured has a favorable view of Obamacare.
• Having health insurance will make people healthier.  It didn't. Based on a two-year randomized study done in Oregon and reported in the May 2013 New England Journal of Medicine, "... after two years there was no significant difference between insured and uninsured in blood-sugar level, blood pressure and cholesterol levels..."
• Having health insurance will reduce costly emergency room visits. The opposite has happened. The Oregon study also found that those with insurance coverage were 40% more likely to go to emergency rooms than those without coverage.

This disconnect between expectations and reality, Barone writes, "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. ...

Arguing that an ObamaCare law might work for "homogeneous populations with high levels of trust, conscientiousness and social connectedness," it doesn't work well in larger populations "where a much larger proportion of people are socially disconnected."

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.