A Health Care Anthem of Optimism

Our understanding of the ACA?

If Disease Management Care Blog's bold prediction holds up and the Supreme Court splits the health care baby by letting the Affordable Care Act (ACA) stand while striking down the "individual mandate," progressives will announce the world is ending, while conservatives will announce Obamacare is ending.

The DMCB argues neither will be true.  When the sun rises the next day, Ms. Pelosi's health care "constitutionality" sputterings will not cease, crafty U.S. House Republicans won't stop their devilish attempts to gut what remains of the ACA and CMS' vast bureaucracy will continue to "innovate" with long-used approaches from the commercial health insurance markets.

The DMCB also predicts that there'll be an emerging consensus that a stumbling White House somehow botched the media-public opionion-wars. According to that narrative, manipulating an unsuspecting "Jersey Shore" addled public with news conferences, speeches, town halls, favorable coverage, framing, biased polling, talking points, press releases, The Daily Show appearances, bloggery, tweets, negative ads, spin, messaging, appeals to "the base," and targeted air-time can convert uninformed numbskulls into opinionated numbskulls.  Talking heads on both sides of the partisan divide would have us believe that but for Americans being educated about the merits of one position vs. another, they'd not only make the correct judgement, it'd be our judgement.

"Bunk!" says the DMCB.

It thinks that by now most Americans "get" the broad outlines of the Affordable Care Act: expanded, mandated and regulated private as well as government-sponsored health insurance that is paid for by the Feds and therefore the taxpayer. Knowing the facts, it's not unreasonable for thinking persons on either side of the political spectrum to agree or disagree with the ACA.  Call the DMCB naive, but it thinks that the general poll trending against the ACA has less to do with media and more to do with the informed judgement and native intelligence of a messy democracy that is underestimated by a cynical partisan elite.

The DMCB is not arguing that the news cycle and media don't have an impact. They do. Yet, when it comes to the ACA, both sides have had an ample opportunity to use all the powers of persuasion to nudge public opinion.  The fact that the ACA has failed to achieve a convincing level of support speaks less to competing messages than the underlying content. In other musical words, it's not the arrangement, but the underlying chord progression.

What to make of all this wreckage?

The ACA's unfavorability, despite a generally supportive news media, suggests Congressional leadership cannot govern from the left.  This is a cautionary lesson for the emboldened Republicans, who may calculate that when their turn comes, they'll be able to govern from the right.

There's good news for health reform.  President Obama's allies forced the issue and, sooner or later, Americans, after trying every alternative, will finally do the right thing. The Supremes and public opinion seem to be telling us that the ACA is not necessarily that right thing. We're still working on it and a plan that can be supported by most Americans will eventually emerge.