Was the ACA worth it?

Do you think having the ACA pass worth every other item on the Democratic agenda? This is a hypothetical of course, but is there any single or slew of items on the Democratic agenda that would be worth sacrificing the ACA for? Like, you can go back in time, tell Obama that if he didn’t push for the ACA, then the country could have gotten immigration reform, mass gun control, 3 more seats on SCOTUS, Democratic control of both houses, stymie gerrymandering of 2010, Democratic president in 2016, etc.

Do you think it was worth it if some combination of the above were the tradeoffs?

ACA might have been worth it if it had had a public option and a lot of other things that weren’t included…or, really, just been flat-out single-payer.

Instead, the Democrats lost 63 seats in the House over a healthcare bill that doesn’t even really improve healthcare or lower costs that much. They should have embraced a “go big or go home” mentality.

The ACA was a disappointing compromise, but I think an important step. Before ACA, insurance companies could refuse to insure you for “preexisting conditions.” That really is barbaric. The conversations/debates about health care hare moving us (slowly) in the right direction. That’s important. More important and some of the things on your list. I also am not ready to concede that not pushing for the ACA would have made any of those other things more attainable.

There was zero chance that the House didn’t flip in 2010, with ACA or not.

There’s a common idea that political parties, when they win elections, tend to “overreach” and then have a hard time in subsequent elections. I maintain that “overreach” is a myth, and that what you see is a predictable pattern of:

  1. Party wins election on an agenda
  2. Party tries to implement agenda
  3. Fickle voters decide the grass is greener
  4. The next election includes some type of change to the status quo

The idea that if political parties sat around with their thumbs up their butts that they would win more elections is simply false. You didn’t directly ask the question of whether the ACA constituted overreach, but I think it’s a point worth making.

Now, as to whether the Dems should have picked their poison before taking losses in the 2010 election, with the choices being: 1) ACA and the stimulus bill, or 2) no ACA, no stimulus, but immigration reform, gun control, three more SCOTUS seats, etc? Well, I think a lot of things on option 2 are in fantasyland (three seats, how? keep majorities, how?) so I have to say that even in hindsight, the ACA part of the deal worked out fairly well.

Of course, had Senator Kennedy not died and taken away the 60-seat majority in the Senate, the ACA itself probably could have been improved before it was passed.

I assume anyone who doesn’t think it’s worth it doesn’t know how health insurance was before.

Do you think that any of those things were sacrificed for the ACA?
Do you think any of those things would have passed if ACA had not come up?
do you think any of those things could have been passed if the ACA had been sacrificed for them?

Because, i don’t see it as a zero sum game. None of the things you mentioned are dead. I get that sometimes deals are made such that “if you forget about this bill, then I’ll back your other”. But these are temporary tablings at worst. And since I am not a legislator, I have no compunction to play politics. i can still insist that my rep work on those other things.

As for the ACA itself, I am happy that it became law in whatever form it did. It was a foot in the door. Now that it’s there it will most likely stay (in some form or other) and we can continue to push it towards a more perfect version.


I think the Dems would have been better off going for something else…this seemed to have been a bit of a 3rd rail for them. Basically, they didn’t get what they wanted, and what they did get left them open to attack…and, frankly, doesn’t seem to have been worth the political capital. Either they should have gone whole hog on real reform for healthcare (which I assume they didn’t think they could do) or focused their political capital on something else. Of course, that would have been tough, since they campaigned on healthcare reform.

Not sure how mass gun control would work out for them, either, but I think they COULD have gone for immigration reform as well as visa/green card reform, both of which are badly needed. Not sure how that would have played out wrt the mid-terms for them, but it wasn’t as much of a hot button issue for the Pubs at that point, so they might have been able to get real, solid reform in and we’d be better off today, IMHO. Really, what I think they needed badly to do was, I think, beyond them then…which was to boost the economy out of the Bush recession and focus on the financial sector. There was just no way to do that, at the time. Not sure if pushing for more stimulus would have helped or would have had tangible results in the time frame we are talking about.

Obama had the option of making a deal with the Republicans to do a light weight deal (there were actually some Republican proposals at that time); he probably should have done that.

The ACA was a Republican proposal. He could have adopted any of the other Republican proposals and still would have faced unanimous opposition.

Yes. It did what it was designed to do (provide insurance to people who didn’t have it) while it was being undermined and attacked constantly. Imagine if it had been supported?

And yes, as someone else wrote above, the reason the GOP are in a bind in coming up with alternatives is that the ACA was the conservative solution. It is the Free Market, Personal Responsibility answer to how to provide insurance to people who don’t have it. Anything “more conservative” wouldn’t work.

I wonder how that would have worked…targeted assassinations?

No, simply getting a presidential candidate elected in the last election would have done it for them (as well as more Democrats in the house and senate during Obama’s administration). No assassination necessary.

I’m not making a reality based argument - it’s a hypothetical. The idea is to explore the contours of what tradeoffs would or would not be hypothetically worth it. Think of it like:

I would give up the ACA in exchange for…
I wouldn’t give up the ACA even if offered…

Aaaah. Now I get you. I have to think about that.

I would give up the ACA for single-payer. When it became clear that the ACA wouldn’t get a single Republican vote, that’s what should’ve happened: Dems should’ve said, “Okay, if you don’t want to join us at the table, if you don’t want to compromise, we’ll show you what you get when you won’t compromise.”

We could’ve lost in 2010, big-time; but imagine the helluva time Republicans would have convincing people that they wanted to return to a world of insurance companies and emergency room bills and worries about losing coverage when you lose your job. Long-term I think it would’ve been an enormous win, on the scale of the New Deal.

There’s honestly a lot that I’d exchange for ACA: I think it’s Exhibit A of Democrats misunderstanding the political climate, thinking that they have a reliable negotiating adversary who approaches the negotiations in good faith.

I’ve talked about this before on the board, but I think it bears repeating.

Between the time my daughter turned 22 and aged out of our family policy, and when the ACA finally passed, not one single insurer would sell her a policy. Not “high deductible,” not “major medical,” not “limited coverage,” not NOTHING. For seven years she was one car accident away from bankruptcy.

Don’t give me hypotheticals. Tell me what exactly what you’d trade for that.

The ACA was crap but it was better than nothing.

One of the reasons democrats lost in 2010 is because they didn’t give their voters a reason to vote for them. I remember that time, democrat voters were very demoralized. We felt like we gave the democrats super majorities in 2006 and 2008, and they wasted them being scammed and outsmarted by Republicans, and pushing for watered down, center right policies. I voted in 2010 and I voted Democrat but I assume millions of democrats just stayed home demoralized and felt like what’s the point.

Has the democrats pushed for genuine reform, they may not have lost as badly in 2010 because their voters would feel like they had a reason to show up and vote. As it was a lot of democrats voted in 2010 feeling like we were voting for a center-right party full of gullible schmucks who didn’t want to pass any legislation that would offend Republicans or the rich.

Having said that, what would I trade the ACA for? Better Healthcare. Maybe Medicare extra or Medicare for all.

I wouldn’t trade it for the Supreme Court.

I don’t think there’s any significant likelihood they could have gotten all that stuff in exchange for the ACA. Maybe one or two things, but that’s it.

Yes, it was worth it. There was gonna be a racist backlash in 2010 almost no matter what. And one in 2016, though perhaps a better Democratic candidate could have weathered it. The ACA is the biggest (and now, finally, one of the most popular) Democratic/progressive achievements in half a century. In the long term it’s utterly enormous and valuable.

Don’t think of it in terms of real politik, but rather in terms of what you would trade for it. For example, I know a big issue for you is how allegations of sexual harassment and abuse are handled - what if the country moved towards treating these items as you think is best, would you trade the ACA for that?

For me, I was an am opposed to the ACA as it was passed (without the mandate I’m not very opposed in practice, but I am opposed that a thing such as the mandate can exist at all), so I look at the question from the opposite direction. I am opposed to the ACA, but if I could get something else that is valuable then I would think that’s a good trade. Something to do with guns or taxes then yeah I would think the ACA was worth it.

I’d trade it for Universal Healthcare.

Does that count?