Reality: ACA is now a fact
The point of no return was reached when millions of people crashed the websites of the new Affordable Care Act exchanges trying to buy health insurance. Republicans can fight rear-guard battles if they want, but last Tuesday they lost the war. All they can do at this point is harm the nation -- and their own political prospects.
Someday, if the GOP captures the presidency and both houses of Congress, President Obama's health care law could be altered or even repealed. But it would be replaced by some new program that does the same thing, because there is no politically viable way to snatch away the medical insurance that customers are buying through the exchanges.
Quite the opposite: As soon as the glitches are cleared up and everyone becomes a bit less hysterical, the question will be how to obtain coverage for as many as 30 million people who will still be uninsured -- including about 8 million ineligible for Obamacare because of a sabotage campaign by Republican governors.
Look at Texas, which the state medical association calls "the uninsured capital of the United States." An estimated 22.5 percent of the population lacks health insurance, a higher percentage than in any other state. Many will remain uninsured because Gov. Rick Perry -- a once and perhaps future GOP candidate for president -- refused to set up a state insurance exchange and turned down billions in federal funds to expand Medicaid coverage.
Rejection of Obamacare may be popular in Texas now. But demographic trends are making the Lone Star State's electorate more diverse, as the Latino population grows, and less reliably Republican. Small businesses that cannot afford to offer health insurance may soon worry about losing employees to states offering better coverage for the working poor through local exchanges and expanded Medicaid. Time is on the side of those who want to expand coverage, not those who want to restrict it.
I trust that conservative leaders will continue riling up the base with the untrue charge that Obamacare is "government health care." It is nothing of the sort. Obama decided at the outset not to push for a government-run health system, such as those in Britain and Canada, or a single-payer system of any kind.
Instead, all of Obamacare's insurance plans are offered by private firms -- the same companies that also provide employer-sponsored insurance. Disappointing his liberal supporters, Obama declined to include even a single public, government-run health plan. All the apocalyptic right-wing rhetoric about socialism and the end of freedom is nothing but hot air. Soon, no one will take it seriously.
Those who are genuinely worried about the cost of a new entitlement should have their concerns taken seriously. But if money is the overriding issue, the obvious thing to do is go further and adopt a truly universal system like those in other industrialized countries.
The United States spends nearly 18 percent of GDP on health care, more than any other nation. France, Germany and Japan, to cite three examples with universal health care, spend between 9 percent and 12 percent of GDP on health -- and obtain health outcomes at least as good as ours.
Someday, fiscal conservatives will acknowledge those numbers. For now, we are stuck with a fee-for-service health care system that is perhaps the most wasteful in the world. Critics of Obamacare seem not to understand that the vast numbers of uninsured Americans -- about 15 percent of the population -- contribute heavily to the system's inefficiencies.
We provide care for these people, but we do it in the dumbest way imaginable. Since they can't afford to see a doctor regularly, treatable health problems and chronic conditions worsen. When ailments become acute, the uninsured go to hospital emergency rooms -- the most expensive way to receive care.
The uninsured cannot pay their bills -- medical costs are the biggest single cause of personal bankruptcy -- so they are passed on to the rest of us in the form of higher health insurance premiums. Families USA, a nonpartisan health care advocacy group, estimated that in 2010 an average family in Texas paid an extra $2,786 in premiums to cover care for the uninsured. Are you listening, Gov. Perry?
Medicare guaranteed health care for the elderly, Medicaid for the poor. Obamacare begins to fill the remaining gaps. It will get better over time, but already -- crashing websites and all -- it's a beautiful thing.
Eugene Robinson is a Washington Post columnist. His email address is email@example.com.
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