We're About to Learn Who Was Right About Obamacare

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The big test for whether the health-care overhaul should survive shouldn't be the 2012 election -- it should be how it performs over the next four years.

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The passage of President Obama's health-care bill and the Supreme Court's stamp of approval caused many conservatives to treat the 2012 election as their last chance to stop the legislation. Democrats were especially excited about their victory at the ballot box in part because it means the entirety of the Affordable Care Act will now go into effect. In both parties, the prevailing assumption is that the law is here to stay -- that once an entitlement takes effect, what Republicans call the welfare state and Democrats call the social safety net has been ratcheted one more click leftward, irreversibly.  

Does Rep. Paul Ryan disagree? Speaking to the National Review Institute over the weekend, he suggested that the Republican Party's opposition to Obamacare is just beginning. "In the president's first term, we argued against big government in theory," he said. "In his second, we will argue against it in practice. Obamacare is no longer just a 2,000-page bill. Now, it's 13,000 pages of regulations. And it's growing. This year, the law will restrict our ability to use flexible-spending accounts. It will even raise taxes on life-saving medical devices. And that's just health care."

As a Republican politician, Ryan has an incentive to overstate the costs of Obamacare, but he's right that it's changing from something exhaustively debated in theory to a policy with real-world successes and failures. If they occur in anything like the ratio Ryan suggests, running on the repeal of Obamacare ought to be easier four years from now than it was in 2012.

On the other hand, the Republicans fought the passage and implementation of Obamacare by running against death panels, socialism, Medicare cuts, and the United States becoming another Europe. So even if the legislation goes very wrong in exactly the ways that wonkier critics like Reason's Peter Suderman predicted, GOP politicians won't exactly be able to say "I told you so." If Obama winds up making the health-care system somewhat worse, even as "death panels" never materialize, market capitalism survives, Medicare endures, and it still doesn't feel like Europe, many rank-and-file conservatives will be relieved, or even pleasantly surprised.  

Hopefully the GOP's rhetorical excesses, ineptitude, and dearth of coherent policy alternatives on health care won't prevent America from having an honest reckoning with how Obamacare unfolds. It's certainly worth comparing its performance to the confident claims made by left-leaning wonks about all the necessary cost-cutting it'll do, among other theoretical features. I expect the unintended consequences to be significant and the cost-cutting illusory. But I could be wrong.

Time will tell.

Unfortunately, the political class is turning its attention away from the law just as it's coming into effect. So it goes when so many people care so much more about politics than governing. I count Paul Ryan among those people, but kudos to him for noting that empirical results are on the way. They ought to be the decisive factor in whether or not Obamacare survives.

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Conor Friedersdorf is a staff writer at The Atlantic, where he focuses on politics and national affairs. He lives in Venice, California, and is the founding editor of The Best of Journalism, a newsletter devoted to exceptional nonfiction.

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