David Leonhardt reminds us of the impressive success of Obamacare, now being built on by Biden, with a public option in the offing. Despite the view of many on the left that the ACA was an intolerable sell-out and their conviction that Trump would easily succeed in nuking such a flawed program, the program is alive and well and headed down the road to universal coverage.
"Obamacare endured a grueling first decade of existence. Its launch was famously clunky. It was unpopular in its early years. It narrowly escaped repeal at both the Supreme Court and in Congress.
But the law — passed in 2010 and more formally known as the Affordable Care Act — has survived. It’s more than survived, in fact. It now stands as a monument to a particular theory of progressive lawmaking: When the federal government enacts a new benefit that makes life easier for millions of people, the program tends to endure. That describes universal high school, Social Security, Medicare, Medicaid and now Obamacare.
President Biden yesterday signed a package of executive actions on health care, and many experts described them as steps to undo Donald Trump’s attempted sabotage of the law. Which they are. But the modest scope of the actions is also a reminder of how little progress Trump made in undermining the law."
He concludes his article with a quote from Jonathan Cohn, perhaps America's best health care journalist, from Cohn's forthcoming book The Ten Year War:
"The Affordable Care Act is a highly flawed, distressingly compromised, woefully incomplete attempt to establish a basic right that already exists … in every other developed nation. It is also the most ambitious and significant piece of domestic legislation to pass in half a century.”
Yes indeed. And very hard to get rid of, as I have consistently argued, as well as very likely to be built on to get us closer and closer to truly universal coverage. From some of my writing on this topic in the early Trump era:
"Over time, the left has accomplished many things, from building out the social safety net to cleaning up the environment to protecting public health to securing equal rights for women, black people, and gay people. These and many other gains of the left have a very important thing in common: They are “sticky.” That’s a term borrowed from economics that means, simply, they will be hard to reverse. They provide benefits that people do not want to lose — and, what’s more, they shift norms of what is right and wrong.
Social Security and Medicare are great examples of policies that once seemed radical and now are simply a part of life. The Affordable Care Act’s core innovations may turn out that way, as well, despite the controversy that has dogged the program from its inception — and the declared intent of the current administration to eliminate it.
The ACA has provided benefits to millions who don’t want them taken away, and helped to establish the principle that every American has a right to health care, guaranteed by the government. That’s why the Republican attempt to radically downsize the program hit a buzzsaw. To be sure, Republicans will keep trying, and they’ll do some damage. But they will not be able to “repeal and replace” with a fundamentally less generous program.
Instead, it’s more likely that the ACA, either under that name or another, will get more generous over time. As conservative columnist Charles Krauthammer...noted: “A broad national consensus is developing that health care is indeed a right. This is historically new. And it carries immense implications for the future. It suggests that we may be heading inexorably to a government-run, single-payer system.”
Krauthammer was despairing, but the left should be heartened by the observation. Indeed, at this point, Trump and the GOP have been reduced to hoping that if they neglect the ACA, it will collapse on its own — yet that doesn’t seem to be happening...The very desperation of this “strategy” is a sign that Krauthammer may well be prescient about where American health care policy is headed."
And there's this:
"Trump and the Republican Congress have declared their intention to roll back [Obama-era] advances and then some. The president has already signed executive orders that seek to weaken Dodd-Frank and undermine the ACA. But can Trump and his GOP allies really get rid of these programs, as opposed to nibbling at their edges? It will not be as easy as they expect and as many on the left fear.
The chaos surrounding Republican efforts to “repeal and replace” the Affordable Care Act illustrates just how difficult this rollback would be. The idea of repealing the ACA first and coming up with a replacement later died quickly, forcing Republicans to confront the fact that they cannot agree on what the new plan should be. Some want to keep the Medicaid expansion, some balk at requiring higher deductibles, some worry about reducing subsidies, and many fear political damage from throwing millions of people off health insurance. The disunity of the repeal forces is so palpable that former House Speaker John Boehner, who once led the charge to repeal the ACA, now admits that repeal is “not going to happen” and that “most of the framework of the Affordable Care Act” will remain in place.
Trump and the Republican Congress fail to understand, and the left would do well to remember, one of the most enduring features of American public opinion. The dominant ideology in the United States is one that combines “symbolic conservatism” (honoring tradition, distrusting novelty, embracing the conservative label) with “operational liberalism” (wanting government to take more action in a wide variety of areas). As political scientists Christopher Ellis and James Stimson, the leading academic analysts of American ideology, note: “Most Americans like most government programs. Most of the time, on average, we want government to do more and spend more. It is no accident that we have created the programs of the welfare state. They were created — and are sustained — by massive public support.”
That’s why, now that the ACA has delivered concrete benefits for many people, it is so very hard to get rid of. As a constituent of Sen. Chuck Grassley (R-Iowa) put it: “I’m on Obamacare. If it wasn’t for Obamacare, we wouldn’t be able to afford insurance. With all due respect, Sir, you’re the man that talked about the death panel. We’re going to create one great big death panel in this country if people can’t afford to get insurance.” In the long run, it is far more likely that the ACA will be built upon and improved, so that it extends coverage and tamps down rising medical costs even further (that will be the “something terrific” Trump has talked about), than truly be eliminated."
Looking back on these writings and that period, I'd have to give myself a pretty good score.
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