By Tom Allen



The start of implementation of Obamacare has triggered a renewed, fiercer response from its critics. During my 12 years in Congress there was no comparable effort to undermine a recently enacted law, including President Bush’s prescription drug bill, which almost all Democrats opposed. Why are Republican Governors and House members—with no plan to replace Obamacare—so determined to destroy it? Why did Senator Ted Cruz say that implementation must be blocked before people become “addicted to its subsidies?” If people are going to like Obamacare’s benefits, why try to blow it up?

Opponents argue that the Affordable Care Act will hurt small business, raise health care costs and reduce economic growth. But if you listen carefully to their arguments, you can detect the underlying fear: if millions more Americans have health insurance, they will be more “dependent” on government. In short, opponents really believe that the country will be worse off if health insurance becomes available for 25 million people who don’t have it today.

To most Democrats this makes no sense. People with health insurance get medical attention more quickly and have healthier lives; the health care system will be more efficient without cost-shifting from the uninsured to commercial insurers and their customers. But right-wing Republicans are convinced that government by its very nature infringes on personal liberty and induces “dependency.” They hate Obamacare precisely because it may cover 25 million people. To libertarian-leaning activists “dependency” on government is a fate worse than having no health insurance at all.

If the ongoing debate about Obamacare was really about cost, access and quality (the health care policy trifecta), the opposition would be less intense and more specific. After all, the core ideas of (1) state-based exchanges regulating competition for beneficiaries by private insurers and (2) an individual mandate to acquire health insurance had a conservative birth. In 1989 Stuart Butler included both ideas in the Heritage Foundation’s proposal for comprehensive health care reform. Twenty-four years ago some conservatives took the need for expanded coverage and reduced costs seriously. The absence of any conservative proposal to “replace” Obamacare is compelling evidence that is no longer true.

In health care as in the other issues covered in my book, compromise between Republicans and Democrats in Congress is impossible because the two sides have incompatible worldviews about what Americans should do together through their governments and what they should do as individuals. Those worldviews, which I describe as grounded in either individualism or community, leave the two camps unable to understand the other and, therefore, unwilling to believe the opposing views are honestly held.

Obamacare was enacted without a single Republican vote, yet in time it will be broadly accepted as an historic change that expanded coverage and held down costs for tens of millions of Americans. The real fear of conservatives is that Americans will be grateful for the specific, concrete benefits of Obamacare and ignore the ideological, unquantifiable “dependency” that is so vividly compelling to the right.

Tom Allen, author of Dangerous Convictions: What’s Really Wrong with the U.S. Congress, is a former U.S. Congressman representing Maine’s 1st District from 1997 to 2009. He is currently President and CEO of the American Association of Publishers

This week we’re offering views and insights from Oxford University Press authors on the Affordable Care and Patient Protection Act in anticipation of open enrollment beginning on 1 October 2013. Read previous articles including Theda Skocpol and Lawrence R. Jacobs: “What does health reform do for Americans?”, Andrew Koppelman’s “Politics, narratives, and piñatas in health care”, and Eileen Boris and Jennifer Klein’s “Who cares for those who care?”.

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Image credit: Unofficial Republican Elephant and Democratic Donkey icons. These images have been created for general use to illustrate editorial content about politics in America, 2011. Graphic by Donkeyhotey. CC 2.0 via Flickr.