Whether Democrats like it or not, the 2014 elections will be a referendum on the Affordable Care Act (Obamacare). Health care is an issue many people care about and are affected by. For example, after the rollout failed to be as smooth as expected, Democratic poll numbers have fallen significantly from their post-election highs.
Enthusiasm has crumbled and independents are beginning to turn against the Obama administration. The split has never been more drastic, both in public opinion and the political elite. While moderates run to their right, saying that the health care overhaul tried to do too much, progressives should be holding their ground against conservative supporters of the status quo. However, just as progressive support is needed most, liberals have ran away from the plan, at their own expense.
For most of the public, the Affordable Care Act is continues to be a tough pill to swallow. Opponents of the law are quick to point out the slippery slope that will lead the United States towards socialized medicine. However, any thinking liberal should respond that the bill enshrines free market principles into an industry that many in the progressive community feel should be a public service.
Nevertheless, the ACA is an obvious improvement to an increasingly expensive and insufficient system. The expansion of Medicaid will cover people up to 33% over the poverty line. Millions of middle class Americans will now get tax cuts to purchase health insurance. The government has taken on the challenge of making sure that health care is available to everyone, and now it must follow through with its promise. Health insurance should be billed as a human right, and the government has enormous capacity to guarantee that right through subsidy, regulation, and oversight.
Progressives should take control of this crucial debate and ensure that health care is discussed on their terms. Here is some advice for advocates:
1. People are still ill-informed about basic elements of the law. People still do not know much about the act. While 38% of Americans approve of Obamacare, 45% of Americans approve of the Affordable Care Act (the actual name of the law). Democrats can try to inform the masses of the content of the law, but the bill is a nuanced improvement of an existing system. Outside of the wonk community, many Americans will never be informed about all of the subtle improvements of the ACA.
2. Bite the bullet of the individual mandate. There is no need to escape the truth. A non-response will never suffice when uninsured Americans are paying fines. The bill included the individual mandate because rights come with responsibilities. The government exists to fulfill the wishes of the community. If the community agrees to subsidize your health insurance and admit that you have a right to health care, you have a responsibility to make sure that your failure to buy health insurance is not a cost to the community.
3. Do not take responsibility for the flawed system. The health care system is flawed. In any price-based system where people have unlimited demand mixed with limited supply, prices will increase. This problem is endemic in a private system. But, this is not a reason that we can't improve the system. The ACA is an attempt to save the privatized system and to mitigate the inequality resulting from an unregulated system where health care is reserved for the privileged few that can afford it. To keep a private system with private providers and insurers, public regulation is needed.
4. Some employer plans may be lost. Rather than try to deny reality, supporters should admit that there some people have lost their health care, but they should explain that the story doesn't end there. So far 4.5 million people have lost their plans, but at the same time, 15 million people will either sign up for exchanges or become eligible for Medicaid. 10.5 million more people have health insurance than before. When the government admits that it has a responsibility to help provide health insurance, more people will use government-subsidized insurance, even if some people have to switch plans.
The Affordable Care Act is a complex solution to a complex problem. It is a progressive shock to the system which has enabled the poor and the middle class to gain access to quality health insurance.