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For what it’s worth, I support Obamacare as a health reform strategy. To the best of my limited understanding, it makes sense as an approach to broadening insurance coverage and controlling costs. Whether or not I am right, the law will have a long-term impact on public views of government and politics. For instance, as I recently told NPR’s Tamara Keith and the Washington Post’s Dana Milbank, young people will draw powerful and lasting lessons from their perception of this initiative. In turn, that may affect their political orientation for the next 50 years.
I can see public opinion of Obamacare crystallizing in three different ways:
1. It is a fiasco that proves the government can’t be trusted. Just when we were learning that the feds can collect private information from anyone in the world (even the Chancellor of the Federal Republic of Germany, our ally), we watched the Obamacare website fail to capture data that people wanted to give it. That crisis has passed, but the whole reform could be seen–rightly or wrongly–as an emblematic failure of government.
People would ask whether more government is better, and their answer would be: No.
2. It is a demonstration of Clinton/Obama-era technocratic liberalism. The government pulls together some experts, mostly employed in universities and industries, and develops a clever set of tweaks to the existing insurance market. By offering individuals new choices in carefully designed market exchanges (while sparingly employing money and regulations), the government nudges employees and employers to act better. The key relationships are all private and transactional: I go onto a website, make choices for myself and my family, and get economic benefits for us. If that approach is seen to work, it strengthens the case for a certain kind of technocracy in which behavioral economics is the reigning discipline.
People would ask whether smarter government is better, and their answer would be: Yes.
3. It is an illustration that we the people can address problems together, using a combination of laws and the state, business and markets, and voluntary collective action. To be sure, that is not the way that Obamacare is being presented, either by its supporters or by its detractors. To its enemies, it is state-centered socialism. To its most prominent friends, it is the government helping individuals. And indeed, it was designed in a basically individualistic way. But the act has provisions that strengthen community health clinics that are governed by public boards. Lawrence Jacobs argues that the $11 billion in new funds for them is a huge investment. This investment could boost civil society and develop new leaders. Meanwhile, Health Access California has been outstandingly successful at signing people up for Obamacare by combining community organizing, education, research, and advocacy. A significant reason for the success of Obamacare, if it succeeds at all, will be this huge collaborative effort in California’s nonprofit sector.
If these aspects of the law were (a) publicized and (b) strengthened in the years to come, people might ask a different question: Can we address social problems together? And the answer would be: Yes.