When the aca was passed I was upset because true health reform requires stepping on toes. True reform that lowers costs and improves quality will enrage the pharmaceutical industry, insurance industry, hospital industry, medical supply industry, doctors groups, etc because true reform will cut a lot of profits and business from them.
But with the attempts to repeal the ACA, these groups fought to keep the law intact. Insurance companies, hospitals, doctors groups, etc all said the gop needs to keep the aca.
Also the medicaid expansion created a situation where state Governors wanted to keep the law. So now even Republican governors are speaking out against repeal.
The law created a coalition of governors, patients, democrats and medical providers all working together to stop repeal.
It’s not a perfect law and we need massive reform to lower prices, but passing the law in such a way that so many people would fight against repeal was smart. I wasn’t thinking that far ahead when they passed it almost a decade ago.
Original Bill: 171 Republican amendments, 0 Republican votes.
This was put in place over every Republican attempt to sabotage it and bring it down, and they’ve spent 8 years preaching how horrible it is and promising to repeal it. Now, as predicted, it is actually working (as much as the flawed, much amended version CAN work) and the Republicans still have no plan on how to improve anything, just burn it to the ground and hurt millions of Americans in the process.
One thing the market (read: Insurance companies and doctors) wants most is stability. There is more than enough paperwork, rules issues and the like without constantly changing the laws or threatening to do so.
But yes, as you say, and even the Republicans admitted (as a scare tactic to their members) when it was passed - it would prove successful enough that if they didn’t kill it right away, it would become popular, it would give millions of people insurance that they didn’t have before, and then it would become almost impossible to repeal.
But as you say, true reform will require stepping on a lot of toes to reduce costs, and frankly, the #1 place that we need to get under control is drug costs. I take Januvia for my Type II Diabetes. It costs $450 a month, which is ludicrous ($15 a day? :dubious:) but yet it only costs $107 a month in Canada, right next door. There is literally no excuse for this kind of profiteering from the American market.
Setting aside the issue of what groups were in the pro-ACA coalition at the outset, and which groups have come around on not wanting ACA trashed, I think there is a more fundamental lesson.
Once you give people something, it is awfully hard to claw it back.
So if you can manage to get the camel’s nose in the tent, odds are that eventually the camel is going to be in your tent, rather than the camel deciding that it wants to turn around and wander away. ACA is the nose in the tent – it’s hard to kick it out, and more likely it will just be followed up eventually with more.
Well put. I think there was (and, hey, may still be – I’m no fortune-teller) a “sweet spot” for repeal when enough people were more concerned about the camel’s nose being in the tent than remembered what life was like before the camel poked its nose in. (Medical bankruptcies, exclusions for preexisting conditions, etc.) When “that damn camel!” overrided concerns about what uncertainties lay outside the tent.
That’s the sweet spot where repeal alone was/might still be attractive enough to pass without significant blowback.
My hunch is that we’ve passed that point – except that maybe we don’t have the long-term memory, as a society, to recall why healthcare reform once seemed so urgent anymore.
A more pessimistic (and ideologically au courant) framing of this POV is this alt-right/neoreactionary maxim: “Cthulhu may swim slowly, but he always swims left.” I wish I could find a short exegesis of this quote right now, but I’ll have to point you to the overlong and overwritten blog post where Mencius Moldbug coined the phrase. Unqualified Reservations: A gentle introduction to Unqualified Reservations (part 1)