The Long Game Of Obamacare

President Obama Visits Boston To Talk About Health Care

The current conventional wisdom is that the ACA is a disaster. Democrats up for re-election in 2014 are running away from it, there remain, according to Sebelius, hundreds of fixes still to be made to the website, the stories of canceled policies have dominated the headlines and the president has rightly been lambasted for grotesque mismanagement of the federal government. He had one core domestic goal for his second term, it seems to me, and he flunked it. Worse, he cannot even admit that he simplified the sale so badly he repeated something untrue. If the website’s functionality is not substantially fixed by December 1, all bets are off.

And yet … Americans have not changed their minds on the ACA much over the last few months. Here’s the poll of polls on it since January of this year:

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Since September, support has actually risen, while opposition has remained flat. Given the fiasco of the website, that’s a surprise. This week’s elections also didn’t prove that it is a huge liability. Opposition to the ACA remains very strong in the GOP base, which doubtless helped Cuccinelli in the final week. But McAuliffe ran explicitly on Medicaid expansion and won. Then there’s the calculation of Ohio governor John Kasich in embracing Medicaid expansion. Consider too the relative success of the law so far in a state like Kentucky of all places. Now along comes a poll from Reuters-Ipsos:

The uninsured view the 2010 Patient Protection and Affordable Care Act, commonly known as Obamacare, more favorably since online marketplaces opened – 44 percent compared with 37 percent in September. It found that 56 percent oppose the program compared with 63 percent in September. A higher proportion of the uninsured also said they are interested in buying insurance on the exchanges, with 42 percent in October, saying they were likely to enroll compared with 37 percent in September.

I don’t want to overstate the case but I think it’s also foolish to understate the impact on many people who will get health insurance for the first time in their lives. This reality will matter politically in the end. See Byron York’s take on the number of winners versus the number of losers in pure monetary terms – and Ed Kilgore’s response. People are also not dumb enough to think that cancellation of their policies or sudden premium hikes started with the ACA. It was a constant in the private sector for years. Yes, disruption will tick a lot of people off. But Obama still has three years to get this entrenched – and once in place, it will be mighty hard to remove for the exact reasons that people are so upset right now. Disruption is always unnerving, especially in an area like your health.

We all take this issue personally, as we should. And I’ve been very lucky to have had excellent employer-based healthcare for years. But always at the back of my mind was the fear that I might leave a job with that kind of security, like at TNR or the Atlantic and the Beast, and be stranded and bankrupted by my pre-existing condition, HIV. We’re looking into our own health insurance plan right now for the Dish in the next year, and I’ll let you know how the process goes. But like many, we haven’t been in a mad rush, we have an insurance broker to help us through the process, and it is hard to express the relief I feel that I cannot be denied coverage because I am a survivor of the plague. If we have to pay more, it’s well worth the relief.

I can’t believe I’m the only one who feels this way.

It’s not the health insurance reform I would have wanted – I’d prefer ending the employer subsidy, mandating no exclusion because of pre-existing conditions and creating a more vibrant individual market, including the option of catastrophic insurance. But the GOP never offered that and are still not offering it.

I also feel – call me a squish if you want – that baseline health security, while not a right, is an enormous social good, and that social insurance against the random vicissitudes of life in no way compromises free market principles. I also realized when I started a small business that I could not personally employ anyone and not provide insurance, without violating my conscience. The step from that to embracing universal care is obvious.

So count me among those who suspect the current fiasco is just the beginning of this story. To listen to the Republican critics, you’d think the previous system was wonderful – whereas we all know it wasn’t, that the private health sector was grotesquely inefficient, and that its costs kept soaring, and free-riders were undermining the entire enterprise. At some point – especially when the GOP has to find a nominee who can appeal beyond the base – the Republicans will have to shut up or put up. And I suspect a platform of repealing what Obama is constructing without replacing it with something very similar will be a big vote-loser.

I may be wrong, of course. I have been in the past. But the long game is always worth keeping in mind.

(Photo: By Yoon S. Byun/The Boston Globe via Getty Images)