Forget Obamacare. How about U.S. health care?

July 3, 2013
Barack Obama (Evan Vucci/Associated Press)
President Barack Obama (Evan Vucci/Associated Press)

I’ve read quite a bit of good analysis of the decision to delay implementation of the Affordable Care Act (ACA) employer mandate.

I’ll just piggyback on all of that to make one small point.

What matters in this — and here I’m talking about policy, not electoral politics or images or narratives or what have you — isn’t really whether “Obamacare” works. What I mean by that is that the Affordable Care Act is a lot of things: It’s a huge law (Republicans weren’t wrong about that) containing all sorts of pieces. Some are interrelated, such as subsidies and exchanges; some are not.

Moreover, many of those pieces have already been implemented and are working fine; others have already been altered or discarded.

The point is that Republican fantasies of repeal have everyone focused on how “Obamacare” is going to work, rather than about how well (or how poorly) U.S. health care is working and will work in the future. The ACA is already part of the status quo, and soon will be even more; a flat-out repeal won’t make sense any more.

Not that I think a flat-out repeal is likely anyway; I think it’s very likely, instead, that the particular programs of the ACA will soon be seen as essential even while Republicans rail against the abstract idea of “Obamacare,” leading to cries to “get Obamacare away from my Affordable Care Act.”

In other words, what we need less of is assessments of how particular changes will affect the ACA and more about how those changes will affect U.S. health care. Because whenever the next round of reform happens (or, pending that, whenever Republicans resume allowing small fixes to be made legislatively), the ACA will very much be the base against which reform will be measured.

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Jonathan Bernstein | July 3, 2013