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Old 04-03-2014, 12:51 PM   #289
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Join Date: Apr 2008
Location: Mid-Atlantic
Posts: 35,526

There are certainly plenty of things about the ACA to be lukewarm about. There are the short-term questions about whether the exchanges have signed up enough healthy clients, or whether they have brought in enough of the previously uninsured. Then there are the long-term concerns about whether the ACA's payment reforms succeed in slowing healthcare inflation. (The Dutch experience suggests that the all-private insurance model, whose chief raison d'etre is to hold down costs, doesn't do this very well.)

But these issues don't explain the bitter opposition to Obamacare. What does? Some of it came early, in response to the unpopular prospect of an individual mandate; Americans tend to bristle when forced to do anything. Some is driven by the experiences of people who have been on the losing end of the law's reforms; while the sick and the poor overwhelmingly benefit, many others will indeed be stuck paying more for insurance. Others are angry to have lost policies which they liked, but which did not meet Obamacare's requirements. For yet others, every frustrating change in the healthcare system has become identified with Obamacare, regardless of whether it actually has anything to do with the law. And Republicans have certainly tried to ensure we hear every single health-related sob story, regardless of whether the facts are confused or untrue.

For the most part, though, opposition to Obamacare now is based on two things. At one level, it's a question of partisanship. Republicans have turned "Obamacare" into a word that much of the country finds inherently distasteful. No matter how well the system performs, it's too late to reverse those associations. At another level, many dislike the basic transaction at the heart of universal coverage: richer people have to basically pay for poorer people's health-insurance. In Kentucky, for example, Republicans are avidly working to reverse the state's Medicaid expansion, even though the federal government pays for the entire thing initially, with the state expected to kick in 10% in the future.
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