What We're Saying When We Praise Obamacare
There was a time in the not-so-distant past when Republicans and Democrats, whichever party was in the minority, truly behaved as the "loyal opposition." Politics was still bare-knuckled, to be sure, and there were profound and honest disagreements on policy, but there were certain things on which one could almost always count: politics ended at the water's edge, for one, and rarely did an elected official question a colleague's patriotism or loyalty. Sure, there was the occasional Joe McCarthy, but that was the exception, not the ruleâand even McCarthy occasionally broke with his own party, or voted in a bipartisan manner. Above all, Senators and Representatives regularly worked across the aisle to get things done, and socialized with each other to boot; doing so was not considered treason by rank-and-file party members, and legislators wouldn't be subjected to a primary challenge for the twin heresies of collegiality and compromise.Â
It's not exactly a secret, for example, that in the 1980s, keenly conservative president Ronald Reagan and outspoken liberal House Speaker Tip O'Neill had a great amount of affection for one another, and worked together often on legislation, even if "working together" was defined as relentless deal-making and compromise. Even "controversial" bills such as The Social Security Act of 1935 and the amendments to it in 1965 which created Medicare and Medicaidâthough demonized and denounced by many prominent conservative politicians at the timeâultimately passed with substantial GOP support. Contrast this with the Affordable Care Act, a hugely consequential piece of legislation for both our society and economy, which passed without a single Republican vote in either chamber. The GOP opposition to the bill, for mostly political reasons that have been analyzed ad nauseam elsewhere, was as unwavering as it was pathetic.
That brings us to the 5 year anniversary of Obamacare, and Democrats are generally bullish about the law. Many articles have been published from a left-leaning side of the debate, gleefully pointing out that all the dire predictions about the laws effects from Republicans in 2010 have not been born out by reality. Jobs haven't been lost, the deficit hasn't ballooned, the economy hasn't crashed, premiums haven't skyrocketed, millions of people have joined the ranks of the insured, the vast majority of these people are satisfied with their coverage, premiums are getting paid on time, nobody's grandmother was killed by a bureaucrat, and on and on. In fact, as it stands now, only a potential 5-4 Supreme Court vote on a silly four word technicality could possibly kill this law, and that decision is still pending. But if the Court dismantles the law, it will be, according to most objective reports, a demonstrably successful law it is dismantling. Obama himself has been proudly pointing out that he was right, and his critics were wrong, and Democrats, by and large, have been gloating along with him.
But there's something left unsaid by both parties about the law's apparent success, and its something my fellow liberals would do well to take to heart. And that is that the Affordable Care Act is exactly the health law we would've ended up with if Democrats and Republicans still worked together like they used to.
A truly liberal law reforming health insurance would look like a European-style "single payer" system, whereby the government pays doctors and hospitals directly from tax revenue, and all citizens are covered. (Indeed, many of us on the leftâthis blogger includedâstill pine for such a system.) Conversely, a conservative law would consider such "socialized medicine" to be sacrilege and go to great lengths to preserve the private insurance market.
A more modest liberal law, then, would at least include a government-run insurance plan as one choice for consumers, in order to compete with the private insurers and keep them honest. Conservative lawmakers would consider such a âpublic optionâ to be unfair competition at best, more evil socialism at worst, and likely not vote "aye" on a bill that included one.
Liberal legislators, if they agreed to preserve the private insurance market, would at least include extremely generous subsidies for those who can't afford coverage, add a vast, mandatory expansion of Medicaid for the poor, and force all states to set up a health care marketplace. A scaled back, more conservative version of such a lawâif Republicans, in turn, agreed to a compromiseâwould make those subsidies a little less generous, make the Medicaid expansion more modest (and optional), and perhaps request a way for states to opt out of creating a marketplace if their governors chose not to play along.
So what, then, is Obamacare? It's not a single payer system. There is no public option. It preserves the private insurance market. The subsidies offered to help people pay for coverage are are relatively modest, Medicaid expansion is optional (that part took a little judicial intervention), and a federal exchange was built to accommodate the citizens of those states whose governors don't wish to participate. And although the law forces insurers to cover everyone regardless of pre-existing condition (and forcing private companies to do virtually anything is anathema to modern conservatives), it off-sets that potentially financially devastating requirement by guaranteeing these same companies millions of new customers via the individual mandate to purchase coverageâa mandate that, although disavowed by them now, was originally a conservative idea to encourage personal responsibility.Â
Is the law perfect? Not by a long shot. But it is exactly the law one can imagine getting after marathon bargaining sessions between Ronald Reagan and Tip O'Neill. Instead, the Democrats essentially negotiated with themselvesâliberal wing vs. Blue Dogsâand with the powerful health insurance lobby. But the end result was the same. The ACA is, in letter and spirit, a bipartisan law... and most Democrats are proud of it, and brag that it's working.
So while today's Tea Party-bullied Republican caucus is disingenuously demonizing a law that very easily could've been drafted by its own party, so the Democrats are praising a law they wrote that includes parts the GOP could easily have concocted.
Sure, maybe a purely progressive version of the law would be even better; perhaps an even more conservative version of the law would have been a pointless, horrible failure. But the fact remains that the law we actually have, the one that has several components for each party to embrace and several for each party to hold its nose and accept, is workingâand it's working because of the kind of political compromise that used to be a daily occurrence in Washington, and ought to be again. It's just that in this particular case, the Democrats compromised with themselves, because the opposition partyâthe one sadly now in the majorityâhas become so irrational, intractable, and dishonest.
Regardless, if you are a Democrat who thinks Obamacare is swell, and you're proudly touting the various metrics by which it is succeeding to friends, family, co-workers, and social media, you would be wise to keep in mind that the law that is succeeding has many conservative principles integrated into it. It is a law that very easily could've come out of a bipartisan committee, if the current opposition were still remotely loyal, or even passably reasonable.











