Officials in nearly half the states have joined the resistance thus far, by declining to establish the health‐insurance “exchanges” essential to the law and/or to implement its costly Medicaid expansion. If states hold the line, then insurers, hospitals, and such — who were counting on those subsidies to offset Obamacare’s taxes and Medicare cuts — will join the chorus demanding that Congress reopen the issue.
The Obama administration probably won’t be able to get exchanges up and running by October in those two dozen states. A Xerox official who makes money implementing those exchanges for states said of the logistical task HHS faces, “These are systems that typically take two or three years to build. The last time I looked at the calendar, that’s not what we’re working with.”
Obamacare still faces a barrage of lawsuits. Those challenging the contraceptives mandate and the Independent Payment Advisory Board won’t kill the law. But they might improve it. Either way, they will keep its negatives high. The Pacific Legal Foundation’s challenge to the individual mandate could take down the entire statute. Kaiser Health News says Oklahoma attorney general Scott Pruitt’s lawsuit is “by far the broadest and potentially most damaging of the legal challenges” related to Obamacare, and “even some health law supporters concede [it] seems correct as a literal reading of the most relevant provisions.” If Oklahoma prevails, “the whole structure [of] the health care reform law starts to fall apart.” Look how panicked the law’s supporters are. Tell me again why now is the time to “accept defeat”?
Continuing to insist on repeal can also help to avoid the looming debt crisis. Congress desperately needs to cut spending. The easiest stuff to cut is (a) unpopular spending that (b) hasn’t started yet and therefore isn’t protected by the kind of organized constituencies that protect existing spending. Obamacare fits both criteria. Since the administration won’t be able to implement it on time anyway, Congress should enact a two‐year delay of its new entitlement spending. That would be a huge victory and reduce federal deficits by $160 billion. Opponents are more likely to get that delay if they keep demanding full repeal.
Following Roy’s advice would prevent opponents from capitalizing on any of these opportunities. Obamacare’s entitlement spending will begin flowing in 2014, and we will never stop it.
Fortunately, as I travel the country speaking about this law, I find that Obamacare opponents are solidly in the Frederick Douglass camp: “Power concedes nothing without a demand. It never did and it never will. Find out just what any people will quietly submit to and you have found out the exact measure of injustice and wrong which will be imposed upon them, and these will continue till they are resisted with either words or blows, or both. The limits of tyrants are prescribed by the endurance of those whom they oppress.”
While Roy criticizes conservatives for their historic inattention to health care, he commits classic conservative errors, such as to stop demanding what is right. Were opponents to accept Obamacare, they would effectively legitimize it — and we would never be rid of it. Roy’s advice is alarming because he isn’t accepting reality so much as shaping it. (If he doesn’t see it that way, he underestimates his own influence.) Another error naturally follows: His alternative — that “fiscally sustainable, fully reformed set of health‐care entitlements” that he imagines the Swiss health‐care system to be — isn’t even an alternative. It is Obamacare.
Roy went metaphor‐hunting in the right war but the wrong theater. To advise Obamacare opponents to “accept defeat” when vigilance could deliver victory is Vichyism.
As big‐screen Gandhi said of his oppressors: “They are not in control. We are.” The great thing about Avik is this: Even if he thinks I’m mistaken, I know he hopes I’m not.