I like to tell opponents of the ACA that before you criticize the law, state your preference for an alternative, because -- remember -- the status quo is not an option. Republican talk of "repeal and replace" is very heavy on "repeal" and light on "replace." Repeal is great politics, because it ignites public hatred. It will not automatically lead to improvement, however, because passing major health-care reform takes many years -- even decades, if history is any guide. Repeal will almost certainly return us to the status quo, with all of its dangers. Replacement has become virtually impossible now, after the 2012 Republican primaries, because no candidate has offered a constructive alternative.
The Supreme Court should also be wary of overturning the ACA, because, as even Justice Scalia noted, how can you surgically remove parts of a 2,700-page bill without killing the overall reform? Justices can only subtract, not add: their proper restraint in legislating from the bench prevents the construction of a coherent alternative.
So let's cool the rhetoric. As we say in Tennessee, "Any mule can kick a barn down -- it takes a carpenter to build one." Where are the carpenters in either political party?
I am the Democrat who wrote the alternative to Clintoncare (Cooper-Breaux), championed the leading alternative to Obamacare (Wyden-Bennett), and who often votes for Band-Aids that Republicans pretend are alternatives to genuine reform -- association health plans, health savings accounts, interstate insurance sales, malpractice reform, and premium support.
Almost all of these centrist and Republican proposals have failed to become law, except for a few demonstration projects, even when Republicans controlled the White House and Capitol Hill. Most of these proposals never had a chance. Nevertheless, I am proud of working hard for bipartisan health-care reform. As Jefferson said, "Great innovations should not be forced on a slender majority." This is particularly true in health-care reform, because health issues are so intimate and existential.
I have the battle scars to prove that there are precious few plans that could conceivably pass Congress, other than the one that recently defied the odds, the ACA. To the dismay of passionate advocates, single-payer has no chance, nor does herding Americans into high-deductible plans. Ideologues on the left and right should put their dream scenarios on hold -- let's make the ACA work. America's greatest strength has always been pragmatism.
Failure to produce more workable alternatives to the ACA is probably one of the worst policy voids in American history. Like Sherlock Holmes' dog that did not bark, this dearth of alternatives is an important clue, at least to our modern political gridlock (if not our permanent decline). Why does an urgent societal problem have so few publicly offered and publicly acceptable solutions? Do we lack imagination, or is Congress unable to embrace good ideas?