The implementation of that bill was a huge challenge, and had many rocky moments. It required educating millions of seniors, most not computer-literate, about the often complicated choices they had to create or change their prescription coverage. Imagine if Democrats had gone all out to block or disrupt the implementation -- using filibusters to deny funding, sending threatening letters to companies or outside interests who mobilized to educate Medicare recipients, putting on major campaigns to convince seniors that this was a plot to deny them Medicare, comparing it to the ill-fated Medicare reform plan that passed in 1989 and, after a revolt by seniors, was repealed the next year.
Almost certainly, Democrats could have tarnished one of George W. Bush's signature achievements, causing Republicans major heartburn in the 2004 presidential and congressional elections -- and in the process hurting millions of Medicare recipients and their families. Instead, Democrats worked with Republicans, and with Mark McClellan, the Bush Administration official in charge of implementation, to smooth out the process and make it work -- and it has been a smashing success.
Contrast that with Obamacare. For three years, Republicans in the Senate refused to confirm anybody to head the Centers for Medicare and Medicaid Services, the post that McClellan had held in 2003-04 -- in order to damage the possibility of a smooth rollout of the health reform plan. Guerrilla efforts to cut off funding, dozens of votes to repeal, abusive comments by leaders, attempts to discourage states from participating in Medicaid expansion or crafting exchanges, threatening letters to associations that might publicize the availability of insurance on exchanges, and now a new set of threats -- to have a government shutdown, or to refuse to raise the debt ceiling, unless the president agrees to stop all funding for implementation of the plan.
I remember being shocked when some congressional Democrats appeared to be rooting for the surge in troops in Iraq to fail -- which would mean more casualties among Americans and Iraqis, but a huge embarrassment for Bush, and vindication of their skepticism. But of course they did not try to sabotage the surge by disrupting funding or interfering in the negotiations in Iraq with competing Shiite, Sunni, and Kurdish power centers. To do so would have been close to treasonous.
What is going on now to sabotage Obamacare is not treasonous -- just sharply beneath any reasonable standards of elected officials with the fiduciary responsibility of governing. A good example is the letter Senate Republican Leaders Mitch McConnell and Cornyn sent to the NFL, demanding that it not cooperate with the Obama administration in a public-education campaign to tell their fans about what benefits would be available to them and how the plan would work—a letter that clearly implied deleterious consequences if the league went ahead anyhow. McConnell and Cornyn got their desired result. NFL Commissioner Roger Goodell quickly capitulated. (When I came to Washington in 1969-70, one of my great pleasures was meeting and getting to know Charles Goodell, the courageous Republican senator from New York who took on his own president on Vietnam and was quietly courageous on many other controversial issues. Roger Goodell is his son -- although you would not know it from this craven action.)