Obamacare was enacted two years ago today. So far, its foremost achievement has been a Republican House of Representatives. But unless its next (and last) achievement is a Republican president and Senate willing to repeal the law, we are in for a world of trouble.
To avoid that trouble and elect that new president and Senate, opponents of Obamacare have to keep the public focused on it, and keep reminding people what is in it and what it holds in store. (Here‘s a grim overview I wrote a couple of days after the law was signed two years ago, which, alas, still holds up on the whole; and here‘s a far better and more thorough one by some of Obamacare’s most able critics.) What is in it is almost unbelievably misguided and disastrous, but it is precisely for that reason that keeping voters focused on it has been a challenge. It’s hard to sustain the level of indignant shock that the law rightly calls for. In just the past few weeks—looking over a couple of the statute’s provisions in relation to various writing projects on the HHS mandate and on Medicare—I have found myself shocked anew at the breadth and depth of Obamacare’s recklessness and folly, not because I didn’t know what it said before but because the passage of time inevitably dissipates the intensity of astonishment. It sometimes takes a renewed exposure to the thing itself, to the fact that it is really there in the U.S. Code, to be knocked back into the proper frame of mind. Others who have spent a lot of time with the law itself seem to have the same experience. I got an email the other day from a friend who teaches health law at an elite law school, and it just said:
Millions of people (e.g., those who make 401% of the poverty line – $43,000 for a single person) will be forced to pay up to $18,000 a year for health insurance without any tax credits or cost-reduction payments. People should find that shocking.
It wasn’t news to him, he was just looking over notes, and it isn’t by any means among the most shocking of Obamacare’s implications, but it shocked him anew. It happens all the time. This law is horrendously bad health-care policy, it rips at the fabric of our constitutional order and our economic order, it makes a joke of any notion of limited government, and it involves a faith in centralized expert management that is utterly disconnected from the realities of modern life. It is the culmination of the liberal welfare state in every respect, and it was enacted just as the failures of that welfare state were becoming most plainly and painfully apparent. It stands to exacerbate and accelerate all of those failures, and so to make the crisis our country faces far more urgent and grave.
But putting all of that before the public in an effective way this year will take work. Most voters know the law is deeply flawed, but very few grasp just what it actually contains and what its implications would be. Helping them to grasp it is perhaps the foremost task of conservatives this year—and it is a political task. We must be very careful not to expect too much of the Supreme Court. However it rules, the Court cannot really lift from our shoulders the obligation to repeal and replace this law. That task requires us to make plain what the law would do, to articulate clearly the problems with it, and to propose an alternative set of solutions to the genuine problems with our health-care financing system—a system terribly distorted by bad federal policy. (Here is a great overview of what that alternative would involve.)
Doing that well will be a foremost task of the Republican presidential candidate—and the idea that, if that candidate is Mitt Romney, his own health-care policies in Massachusetts would get in the way of that work strikes me as a gross underestimation of material that Obamacare offers for a political campaign to work with. It’s probably a function of the view that the individual mandate is somehow the essence of what’s wrong with Obamacare—the view that has also led us to focus excessively on the Court. It’s a view that could only result from not really having contended with what this law involves. What’s wrong with Obamacare begins with the basic vision of government and of American life that underlies it, and is evident in every provision, every new unrestrained regulatory power, every new agency and subagency, every assault on individual liberty, basic economics, and simple common sense in the law. Very little of it bears much relation (or could really, given the nature of our health-care system) to anything any state has done.
The course of our politics and public opinion in these first two years of Obamacare provide much cause for hope that year three will be the last for this odious law. But there is a lot of work to do.
Yuval Levin is the Hertog fellow at the Ethics and Public Policy Center and the editor of National Affairs.