On Obamacare

“Every ground commander seeks the battle of annihilation; so far as conditions permit, he tries to duplicate in modern war the classic example of Cannae.”

— Dwight D. Eisenhower, Crusade in Europe, 1948

“This is essentially the collapse of health care reform in the United States Senate. Honestly, the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill.”

—Howard Dean, December 16, 2009

The Republicans are having a gay old time trying to repeal the Patient Protection and Affordable Care Act. As long as Paul Ryan draws breath they still have a chance to kill it off, but it’s taken them almost a month to even begin to get rid of something they’ve denounced for most of the last decade. This is the easiest time to get things through Congress, yet they can’t do it. But let’s talk some history.

Many of you may not remember this, but back in 2009 and 2010 there was a very, very spirited “kill the bill” effort against the ACA. No, not the Republican effort, but one from the left. It really took off after Joe Lieberman, scum of the earth, refused to support any health care reform legislation that included either a public option on the Marketplace or a lowering of the Medicare-eligible age to 55 (a.k.a. single-payer). This meant that the law wasn’t going to include government-provided health insurance (the Medicaid expansion, also single-payer, was and continues to be ignored).

The argument in favor of killing the ACA and starting over essentially had two parts:

  1. It was a Republican plan written by the Heritage Foundation.
  2. It would give billions of dollars to the insurance companies and entrench our wicked healthcare system for all time. Passing the ACA would not just be bad reform, but it would make future reform impossible.

Therefore, it was better to regroup and come back with a better plan, and better Democrats. Whenever that would be was not made clear.

Scott Lemieux at LGM has made it a personal crusade of his to disprove the first point. Please read those posts, but if you won’t, I’ll summarize: The Heritage Foundation plan required people to buy health insurance… while deregulating the health insurance market, gutting Medicaid, eliminating employer-provided insurance and turning Medicare into a voucher system. The ACA requires people to buy health insurance… while regulating the health insurance market to expand care and consumer protections, massively expanding Medicaid, preserving employer-provided insurance and strengthening Medicare. Exactly the same, right?

Of course, there’s also the obvious point that if the ACA were everything the Republicans wanted, they were wasting a lot of time trying to destroy it. Yes, Obama supported it, but you haven’t seen the Republicans returning stimulus cash or opposing charter schools, things he also supported. The reality is that the ACA is everything the Republicans hate. There is no Republican plan for universal health coverage because they have never wanted universal health coverage. The Heritage plan was created solely so the Republicans could say they had an alternative for Hillarycare. When you think about it for a second, its insincerity is self-evident. The Underpants Gnomes put more thought into their scheming. It’s as if we were trying to stop malaria, and my recommendation was nuking Africa. The Republican “plan” was to strip away all protections in the health care system while maintaining a veneer of coverage. The ACA is not that. Sadly, with many on the left it was perceived that way.

On the second point, the events of recent weeks have given us the answer. The ACA definitely sent a lot of money toward the insurance companies. It forced people to buy health insurance or pay a penalty. It did not do enough to bend the cost curve. It definitely did not go far enough in providing comprehensive healthcare for all Americans (for instance, undocumented immigrants were explicitly excluded). Many people still have to make the impossible choice between healthcare and financial security.

But the ACA did not entrench private health insurance for all time. It entrenched the idea that health insurance is a great thing to have and it would be a bad thing to take it away, regardless of who’s providing it. It turns out that people who got insurance didn’t develop a deep love for free markets, but instead a love for having health care. Gaining health insurance and then being threatened with its loss galvanized them far more than never having it in the first place. In the wake of the ACA’s implementation, the Democrats did not discuss reducing subsidies or privatizing Medicare, as some warned, but instead discussed ways to get the public option back into the law. We even began to talk about single-payer, which was a total afterthought back when Obama was elected. And the Republicans are in a bind. They know just how unpopular total repeal is. The only way to reform the ACA (and it does need reform) without taking away health insurance from millions of people is to make it more liberal, not less. It did not surrender our country to insurance companies for all time; rather, it’s brought the question of whether we need them at all to the forefront.

The ACA was not everything we wanted. It’s not everything we need. Like all idealists, I dream of the clouds parting and the light of the progressive paradise inundating all. The ACA is not that. But it is a light in the darkness. The sheer trouble the Republicans are having trying to scrap it prove that it was a step toward a better world, and that it made a difference. More than 20 million people have health insurance now because of it. It gave progressives the foundation necessary to move the goalposts in the right direction. California was able to introduce a single-payer healthcare bill today because Obamacare established in law the fundamental truth that people have a right to healthcare. Success begets success. And despite everything that’s happened recently, the ACA remains a success. Incomplete, but successful nonetheless. America is a better place because the Democrats didn’t kill the bill. Remember that the next time we get a chance to bend the arc of the moral universe.



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