EDIT: Originally published under the title: Why I Hate Obamacare. People were getting distracted by the title.

Maybe hate is too strong a word. But I really don't like Obamacare. When the GOP talks about costs - they are right. The costs could be enormous. Industy's love for the bill makes me very suspicious. Let's think about why and locate the culprits (hint: It's the GOP). It's time for a history lesson.


Lo these many years ago, left-wing democrats were arguing for a true national healthcare system, in which the government would fund all costs for everyone. We will call this "Medicare-for-all,

The Republicans resisted, refusing to even consider such a thing, though they did help pass universal emergency-room access and Reagan signed this in 1986. This helped many people. It did so in the least efficient way possible, but let's not overlook the genuine help.

Then Clinton was elected and Hillary started the famous health-care debacle. Many plans were floated, but the issue quickly became toxic, 1994 elections followed, and no serious attempt at health-care returned.

In the meantime, both right-wing and left-wing think tanks (I never thought I would miss the Heritage foundation, but it really did have a lot of smart people thinking about market-based solutions to real problems. They even allowed conservatives to disagree with each other and engage in healthy debate), continued to work with the issue of healthcare.

There was basically a universal agreement among all serious people that something had to change in our system.

Moderate democrats, starting at Yale, came up with the "public option." Moderate Republicans at Heritage came up with the "individual mandate." In the meantime, states started to experiment. Romneycare. MNcare. Healthcare for poorer kids. Lots of ideas out there, some working better than others.

Medicare Part D is instructive. Everyone agreed that seniors needed help paying for drugs. One could approach the problem of seniors trying to get drugs in all sorts of ways: One could simply pay for them via medicare. One could regulate the pricing on the market. One could highly limit the patent system so that competition would ensue. One could enable generics to undermine expensive drug pricing. Instead, the Republicans created a program that doesn't actually cover the cost of medicines for many lower income seniors (like my father-in-law), but DOES give hundreds of millions of dollars to the Pharma industry. Of course, lots of Democrats voted for it, because who wants to vote against drugs for seniors?

In 2008, people like me wanted a debate between Medicare-for-all and the public option. Instead, Baucus declared the former DOA because it wouldn't get Republican support - and presumably because he actually thought it was too liberal.  Months passed. Meetings, debates, collaborations, as the Democrats rejected their own ideas, one after another, in pursuit of support from any Republicans.

Medicare-for-all: not even on the table.
Public-option: But, said Republicans, that won't be fair to our corporate masters, because people will choose the public option and put them out of business because it will be so much better (so much for competition).
Lowering medicare to 55 - can't do that thanks to Lieberman (but let's not focus on Joe, as also the GOP had by that point made its radical turn).

Finally, the Democrats chose a Republican plan generated by a Republican think tank and implemented by a Republican governor - and future presidential candidate - as a solution sure to get bipartisan support.

People like me worried: Instead of providing healthcare, the government would make sure that people received massive subsidies - money paid directly to the industry that had been so unethical, expensive, and inefficient for so many decades.  

The government would allow people to buy affordable healthcare and pay the industry to provide it. In theory, the regulations would keep it honest and affordable, but I had my doubts. Any sensible person had their doubts as soon as they saw the industry lobbying for it.

The truth is - we don't know yet. Cost estimates are coming in nice and low for taxpayers. Taxpayers will be able to buy insurance on the exchanges for reasonable rates. But that doesn't mean that the true costs of healthcare are going down, because we haven't seen what the subsidies look like.


Tomorrow, the GOP is going to shut down the government. When you can get GOP officials to talk about the problems with Obamacare, they talk about a bill passed under dodgy circumstances, without true debate, without any bipartisan support. If the Democrats passed this bill alone, they argue, the GOP can repeal it alone (except for the inconvenience of not being able to win elections). When you ask them why, you'll hear a lot of talk about costs.

Some of that talk is true. The costs are real.

They are real because Obamacare relies upon the Republican "idea" that you can solve problems by paying industry to do something, rather than the government just doing it themselves.

It will not be efficient.

It wasn't efficient for student loans (empowering banks to make govt guaranteed loans at higher rates of interest).

It wasn't efficient for Part D.

It won't be efficient for the ACA.

It will, however, enable a lot of people get healthcare.

A few final thoughts: When someone says that the ACA "passed without honest debate" - They are either forgetting or lying.  We remember the months and months of debate before the GOP decided that the pathway back to power was nihilism. we remember these months because that's when the Democratic House, Senate, and President decided to implement Republican ideas.

When someone says the bill "passed it without any GOP support" - They are forgetting or lying about the great efforts, including the betraying of core left-wing values, to bring any Republicans on board. You can't force the GOP to support it when they have made the political calculation - a correct one  as it turns out - that it's more important to destroy Obama's presidency and regain power than it is to work on the healthcare system. That decision has brought the GOP power.

And still, many republicans refuse to admit there is a healthcare problem. They invoke  Reagan's emergency room law from '86, though they don't like to tie it to St. Ronnie. . Millionaire GOP officials and media personalities say, "We have the best healthcare in the world." They say, "Folks just go to emergency rooms and everything is fine." I hear it constantly. Ted Cruz just said that if someone wants healthcare, they should just go and get a job that provides healthcare. Problem solved!


I can accept that some people have a political and moral code in which providing universal healthcare is not necessary. I disagree, both ethically and pragmatically, but I can accept it.

It's the people who claim they care and yet rail against the ACA for whom I have no respect. Because the ACA is not the end of the world. It will help people get care. Its benefits will likely outweigh its costs. It will certainly be good for the millions who now get healthcare who couldn't afford it. But it will be expensive and it will be inefficient, and it will be these things because it is based on the core conservative philosophy - government money can only be spent if it enriches industry along the way.

This has to be just a step along the way to a better system. I don't think we'll get Medicare-for-all, but we can get to a more tightly regulated insurance market.


I am history professor and essayist for the likes of CNN, The Atlantic, and The Nation.

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