The President’s press conference today was mostly about security issues, but it also included this:

…Now, I think the really interesting question is why it is that my friends in the other party have made the idea of preventing these people from getting health care their holy grail. Their number-one priority. The one unifying principle in the Republican Party at the moment is making sure that 30 million people don’t have health care; and presumably, repealing all those benefits I just mentioned — kids staying on their parents’ plan, seniors getting discounts on their prescription drugs, I guess a return to lifetime limits on insurance, people with pre-existing conditions continuing to be blocked from being able to get health insurance.

That’s hard to understand as a — an agenda that is going to strengthen our middle class. At least they used to say, well, we’re going to replace it with something better. There’s not even a pretense now that they’re going to replace it with something better.

Q: (Off mic) —

PRESIDENT OBAMA: The — the — the notion is simply that those 30 million people, or the 150 million who are benefiting from the other aspects of affordable care, will be better off without it. That’s their assertion, not backed by fact, not backed by any evidence.

It’s just become an ideological fixation.

Well, I’ll tell you what — they’re wrong about that. There is no doubt that in implementing the Affordable Care Act — a program of this significance — there are going to be some glitches. No doubt about it. There are going to be things where we say, you know what? We should have thought of that earlier, or this would work a little bit better or this needs an adjustment. That was true of Social Security. That was true of Medicare. That was true of the children’s health insurance program. That was true of the prescription drug program part D that was rolled out by a Republican president and supported by Republicans who are still in the House of Representatives.

That’s true, by the way, of a car company rolling out a new car. It’s true of Apple rolling out the new iPad. So, you know, you will be able to, whenever you want, during the course of the next six months and probably the next year, find occasions where you say, aha, you know what? That could have been done a little bit better, or that thing — they’re kind of making an administrative change. That’s not how it was originally thought this thing was going to work.

Yes, exactly, because our goal is to actually deliver high- quality, affordable health care for people and to reform the system so costs start going down and people start getting a better bang for the buck. And I make no apologies for that.

And let me just make one last point about this. The idea that you would shut down the government unless you prevent 30 million people from getting health care is a bad idea. What you should be thinking about is, how can we advance and improve ways for middle class families to have some security so that if they work hard they can get ahead and their kids can get ahead.

Nice framing of the issue, I’d say.

Republicans in Washington are determined to sabotage the Affordable Care Act. This week already, Sen. Mike Allen (R-Utah) proposed a government shutdown if Obamacare isn’t repealed. Steve Benen lists several other ways Republicans are determined to either stop the law or make sure it doesn’t work.

Ed Kilgore:

It’s taken a few years, but the GOP has managed to talk itself into a very firm belief that this national version of Mitt Romney’s Massachusetts health plan is a satanic abomination that will either, depending on which talking point they are following at any particular moment, crash and burn taking the entire U.S. economy down with it, or succeed in seducing Americans to sell themselves into the voluntary slavery of “socialized medicine.”

If they really believed it will crash and burn, I don’t think they’d be quite so frantic to stop it. If it crashes and burns, this would give the GOP a great issue for the 2014 midterms. If they really believed it will crash and burn, I think they would just step aside and let it. But if they can sabotage it …

Paul Krugman wrote a few days ago that Obamacare is the Right’s worst nightmare —

Yglesias is right: there will be bobbles along the way, but this is going to become an immensely popular program. By the time Liz Cheney challenges Hillary Clinton’s reelection campaign, there will be signs at the rallies declaring “Don’t let the government get its hands on Obamacare!”

Conservatives are right to be hysterical about this: it’s an attack on everything they believe — and it’s going to make Americans’ lives better. What could be worse?

Byron York probably speaks for many righties when he says that once Obamacare is in effect, it will be too late to repeal it entirely. That’s because people will like it. He says,

When Washington conservatives gather to talk among themselves, and the discussion turns to Obamacare — it happens pretty frequently — it’s not unusual to hear predictions that the president’s health care law will “collapse of its own weight.” It’s a “train wreck,” many say, quoting Democratic Sen. Max Baucus. It’s unworkable. It’s going to be a big, smoking ruin.

So what’s the problem?

On the other hand, a lot of thoughtful conservatives are looking beyond Oct. 1 to Jan. 1, the day the law (except for the parts the president has unilaterally postponed) is scheduled to go fully into effect. On that day the government will begin subsidizing health insurance for millions of Americans. (A family of four with income as high as $88,000 will be eligible for subsidies.) When people begin receiving that entitlement, the dynamics of the Obamacare debate will change.

At that point, the Republican mantra of total repeal will become obsolete. The administration will mount a huge public relations campaign to highlight individuals who have received government assistance to help them afford, say, chemotherapy, or dialysis, or some other life-saving treatment. Will Republicans advocate cutting off the funds that help pay for such care?

The answer is no. Facing that reality, the GOP is likely to change its approach, arguing that those people should be helped while the rest of Obamacare is somehow dismantled.

What the GOP continues to ignore is that the rest of it can’t be dismantled without dismantling all of it. The program is about a lot more than subsidies. The many moving parts work together to make it possible for more people to get insurance. Even many who don’t get subsidies will be paying lower premiums.

So, yeah, it’s starting to sink in to some of them that they’d better kill Obamacare now, or they’re going to find themselves in a far more unfavorable political landscape.

See also Jonathan Cohn, Conservatives Brace for the Possibility Obamacare Won’t Totally Suck and Charles Pierce, Mike Lee’s Latest Great Plan.

This is good news for me, anyway —

State insurance regulators say they have approved rates for 2014 that are at least 50 percent lower on average than those currently available in New York. Beginning in October, individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly. With federal subsidies, the cost will be even lower.

Supporters of the new health care law, the Affordable Care Act, credited the drop in rates to the online purchasing exchanges the law created, which they say are spurring competition among insurers that are anticipating an influx of new customers. The law requires that an exchange be started in every state.

As of this writing, this story has not been made available on the Fox News website.

Republicans are banking on the failure of the evil Obamacare to restore their political fortunes in 2014 and 2016. But Ramesh Ponnuru warns them they must not be complacent. Oh, it’s going to be a disaster, he says, but perhaps not disastrous enough.

Opponents of Obamacare should plan instead for the likelihood that in its first years of full operation the law will fail in undramatic and unspectacular ways. Premium increases, cost overruns, and the like may keep the law from becoming popular, but they will not prompt the third of the public that supports it to switch sides, or even get its many soft opponents fired up about it. Meanwhile, the administration will spend millions of taxpayer dollars to advertise the law’s benefits. The law’s dogged defenders will explain away all the disappointing developments, and the polls, as the result of continuing opposition in red states. A few conservative lawmakers have speculated that the law will crash so badly that the Democrats will themselves demand repeal in the next couple of years. That is not the way to bet.

Republicans’ confidence that Obamacare will collapse has contributed to their lassitude in coming up with an alternative. It is a perverse complacency. If the program were going to collapse in the next three years, it would be all the more important for Republicans to build the case for a replacement for it. We can be sure that the Left would respond to any such collapse by making the case for a “single payer” program in which the federal government directly provides everyone insurance.

Ponnuru thinks a third of the country supports the health care reform law. A CNN/ORC Poll (they poll orcs?) taken May 17-18, 2013, found that 43 percent of Americans favor the law and 51 percent oppose it. However, only 35 percent oppose it because it is “too liberal.” The remainder of the opponents don’t think it is liberal enough. So it’s really just over a third who see it the way Ponnuru does. But let’s continue.

Jonathan Chait thinks that it’s politically smarter for the Republicans to not put forward an alternative plan, because that would expose what nitwits they are. Well, that’s not how Chait puts it, but that’s basically what he’s saying.

Republicans have wisely decided to attack Obamacare without committing themselves to an alternative because the alternative would be easy to attack. Ponnuru, for instance, suggests changing the tax code and stripping regulations to create “a market in which almost everyone would be able to purchase relatively cheap, renewable insurance policies that protected them from the risk of catastrophic health expenses.” Telling tens of millions of Americans they’ll lose their insurance that covers basic medical expenses and get bare-bones policies with thousands of dollars in deductibles is not a winning play.

Republicans are doing a good job scaring people with highly misleading claims about “rate shock.”

But the vast majority of the public is not going to see any changes under the new law. Even if the Obamacare exchanges collapse, they only bring in people who don’t have Medicare or employer coverage anyway and are already suffering through a dysfunctional individual insurance market. The “shock” is going to be felt by conservatives who are expecting their Randian fantasies of socialist dystopia to come true.

Timothy Egan writes,

The early indications are that most Americans will be pleasantly surprised. Millions of people, shopping and comparing prices on the exchanges set up by the states, are likely to get far better coverage for the same — or less — money than they pay now. The law, as honest conservatives predicted, before they orphaned their own idea, is injecting competition into a market dominated by a few big names. …

…“The surprise is that, for many in the individual market, the premiums will be lower and the benefits so much richer,” said Mike Kreidler, the state insurance commissioner in Washington. “Eventually, I can see the Affordable Care Act being embraced like Medicare, because once people get used to this kind of coverage, it’s going to be a pretty abhorrent thing to try and take it away.”

Egan compares today’s “ossified right” to conservatives who predicted dire things about Social Security and Medicare — before they went into effect. The question is, how long will the Right be able to keep the fear-mongering going once the law goes fully into effect? I expect that next spring we’ll be inundated with all kinds of stories hyping every little glitch. But if the sky does not fall, will the fear-mongering have an impact on the mid-terms in November? We’ll see.

Sorta kinda related — “How Do They Sleep at Night?“

Ben Smith warns that President Obama is about to “screw his base.”

The passionate supporters are the youth, who voted for him by a margin of 60% to 36%, according to exit poll samples of people 29 and under. His enemies are the elderly: Mitt Romney won 56% of the votes from people 65 and over. And while one of ObamaCare’s earliest provisions was a boon to the young, allowing them to stay on their parents’ insurance through the age of 26, what follows may come as an unpleasant surprise to many of the president’s supporters. The provisions required to make any sort of health insurance plan work — not just ObamaCare, but really any plan of its sort — require healthy young people to pay more in health insurance than they consume in services, while the elderly (saved by Sarah “Death Panels” Palin from any serious attempt to ration expensive and often futile end-of-life care) consume far more than they pay in. There is always a push and pull, however, and this year will be spent laying plans to shift the burden further toward the young.

Before I go on to the main point, I want to say that I find the use of the word “enemies” a bit jarring. I don’t think a rational politician thinks of voters who vote against him as his “enemies,” but rather as a pool of people he wasn’t able to reach. Ben Smith also seems to be implying that the President should heap bennies on the young for voting for him and kick the old to the curb, rather than just do the right thing for everybody.

A larger point is that conservatives persist in supporting the idea of paying for health care through the private insurance industry, yet they also persist in being ignorant of how insurance risk pools work. If everybody only paid in what they received back in services, it wouldn’t be insurance any more, would it?

The main point is that we all get to take our turns being young people, then middle aged people, and then old people. Unless we die young, of course. Assuming an average life span, today’s hunky young dude is tomorrow’s shriveled old geezer. As individuals, we move around in the risk pool — sometimes we’re in the shallow end, sometimes we’re in the deep end — which is why risk pooling is preferred to just making people pay for stuff. In the course of a lifetime, we all take turns being givers and recipients. This is how insurance works.

Rick Ungar at Forbes explains the situation:

According to AHIP, the average premium paid by a 24 year old in the individual marketplace is $1200 a year. Using AHIP’s numbers, the price of making the cost of heath insurance more equitable for a 60 year old will potentially cost that 24 year old, on average, an extra $45 a month.

While I don’t mean to minimize this increase, as I recognize that every dollar counts when one is young and getting started, it is important to keep the actual price tag in perspective and weigh the equities when considering that those at the older age range have been overcharged for many years.

The reality is that the young have been paying unreasonably low premium rates for for a very long time–it being in the health insurance company’s profit interest to bring in as many young and healthy people as possible in the door by charging artificially low rates. The problem is that they make up for it by charging artificially high rates to the older people the insurance company would rather not have in the first place. What the ACA seeks to do is correct this situation so that 60 year olds are not precluded from gaining health insurance coverage by being priced out of the market.

I did some checking and found out that in some states, insurance companies are allowed to charge their older policy holders ten times more than the younger policyholders. When Obamacare fully kicks in next year, insurance companies will be allowed to charge their oldest policy holders no more than three times more than they charge the youngest ones.

Naturally, the Right frames the change as screwing the young. What’s sad is that so many older people have been bamboozled into thinking that the Right is on their side, when it plainly isn’t.

Next year, insurance companies must also stop charging women higher premiums than men just because they are women, as they do now. By the Right’s logic, Obamacare is unfair to men.

And, of course, it occasionally happens that a young person gets cancer or gets hit by a bus. By the Right’s logic, older people facing multiple health problems must kick in higher premiums to pay for that person’s care, but not the other way around.

It’s also the case than when an uninsured 50-year-old runs up a staggering medical bill before he dies, his 20-something children will be stuck with the bill. Paying $45 a month more to help Pops keep his insurance policy is a bargain in comparison.

If we want to help young people, how about doing something toward lowering the cost of higher education and student loan debt? And if you want to make health care as equitably low-cost as possible, how about single payer?

Update: Zandar comments,

Holy crap, Ben Smith has discovered ACTUARIAL SCIENCE. Healthy people paying for premiums and not consuming health care pays for sick people who are consuming health care. ALERT THE INTERNETS.

Update: Sarah Kliff explains why young people probably won’t be hurt by a spike in insurance premium cost.