I'm not a historian, so maybe there's something I don't know, but it seems to me that there may never have been a piece of legislation that has inspired such partisan venom as the Affordable Care Act. Sure, Republicans hated Medicare. And yes, their rhetoric at the time, particularly Ronald Reagan's famous warning that if it passed, "We are going to spend our sunset years telling our children and our children's children, what it once was like in America when men were free," was very similar to what they now say about Obamacare. But once it passed, their attempts to undermine it ran more to the occasional raid than the ongoing siege.
I bring this up because Kevin Drum makes an unsettling point today about the future of Obamacare:
No, my biggest concern is what happens after 2014. No big law is ever perfect. But what normally happens is that it gets tweaked over time. Sometimes this is done via agency rules, other times via minor amendments in Congress. It's routine. But Obamacare has become such a political bomb that it's not clear that Congress will be willing to fix the minor problems that crop up over time. There's simply too big a contingent of Republicans who are eager to see Obamacare fail and are actively delighted whenever a problem crops up. This has the potential to be a problem that no other big law has ever had to face.
It's hard to overstate just how enormous a symbolic presence Obamacare has come to occupy in Republicans' minds. They've invested so much time in not just criticizing it but telling their constituents that it is the worst thing to ever happen to America—and yes, sometimes they literally say things like that—that they've lost all moral perspective. To them, trying to fix a feature of the law so that it works better or helps people more would be a horrifying moral compromise, tantamount to sending fur coats to the guards at Stalin's labor camps in Siberia. If you say to them, "Look, it's the law now—why don't we make sure it works as well as possible?" it just won't register.
Combine that with the fact that in general, congressional Republicans have stopped caring much about policy at all, and they never cared about health care in the first place. They don't want to know the details of issues; it just isn't their priority. In the House, conservatives are spending their time clamoring for an opportunity to cast yet another vote to repeal Obamacare. "The guys who have been up here the last two years, we can go home and say, 'Listen, we voted 36 different times to repeal or replace ObamaCare," said Mick Mulvaney of South Carolina. "Tell me what the new guys are supposed to say?" Your tax dollars at work.
You can look at this state of affairs and assume that as new difficulties with the law come to light, it will be possible for the Obama administration to address them with administrative action, through the Department of Health and Human Services. And that may be true to an extent. But other changes could require legislation, and it's a fair bet that no matter what is involved, Republicans in Congress would reject anything having to do with the law that didn't involve repealing it. You could tell them that there was a typo in the bill which was causing orphans to be turned into Soylent Green and all it would require to fix was a quick voice-vote, and they'd say no, because Obamacare kills freedom.
And let's not forget, it's entirely possible that 45 months from now, there will be a Republican president. If that happens, it's possible that in order to get confirmed, his or her nominee to be secretary of Health and Human Services will have to pledge to Senate Republicans to work every day to dismantle Obamacare. The clock is ticking.