Underlying fierce Republican efforts to stop President Obama’s health care law and the White House drive to save it is a simple historical reality: Once major entitlement programs get underway, they quickly become embedded in American life. And then they grow.Obamcare is not an entitlement. It doesn't begin to compare with Medicaid, Medicare, or Social Security in structure or universality for the population it serves. It's also a not bad at all deal for private insurance; they play by a few new rules, they get a ton of new customers. The ACA is not an entitlement, but a combination of extremely necessary regulatory reform and tax credits. But that new program should grow explosively, because it is so desperately needed.
That makes the battle over the Affordable Care Act more consequential than most Washington political fights. “If it’s in place for six months, it will be impossible to repeal it or change it in ways that significantly reduce the benefits,” said Robert D. Reischauer, a Democrat who used to lead the Congressional Budget Office.
Douglas Holtz-Eakin, another former C.B.O. director, reflects the concern of fellow Republicans in framing the stakes more dramatically. Either the law’s health insurance exchanges “can’t cut it,” he explained, or “it’s Katie, bar the door—we have an explosively growing new program.”
That need, once Obamacare is fully implemented (provided it is successfully implemented), will make the law a success. Democrats should have faith in that. It's what Republicans have been certain of from the beginning. That's why they've worked so hard to try to kill it. Right now, making it work is the most important thing any Democrat can do. That's for their own political future, and more importantly for the sake of their constituents.