I mean the law and its consequences, its regulations and taxes, its causes and its effects are messy. Winners and losers abound. This is true now and will be true for as long as the law remains. And remain it likely will, precisely because of the tight and self-reinforcing alliance the law constructed with insurers, hospitals, and doctors. Americans who lacked insurance coverage will find it through the private sector on federal or state exchanges or via Medicaid. Americans who had policies on the individual market will lose their old coverage and possibly find new and better coverage or more expensive and inferior plans. Americans employed by large corporations will see modest changes in benefit and premium schedules, and those who work for smaller companies may see previous coverage vanish and choose new options that may or may not live up to their expectations. All of this will be destabilizing and generate in different regions and among different demographic groups anxiety, possibility, relief, and rage.
In this, Obamacare will unintentionally but unmistakably resemble the old system—where these powerful emotions and wrenching economic dislocations were common but engineered entirely by the private insurance market. To cover those who lacked insurance, Obama decided to interpose the federal government in this messy market, and his hyper-simplistic rhetoric about keeping insurance plans and doctors exposed his contempt for public discourse and corroded his credibility, by far the most durable personal attribute of his presidency.
Obama’s rhetoric has been his political undoing, driving his poll ratings to new lows and grinding his other legislative ambitions to dust. Obamacare has become a crucible of accountability and believability. Within that confined space, made hotter and more vaporous by his own discredited platitudes, Obama’s ability to lead, inspire, and persuade has suffered. But the law remains, and the next four months will be but the first of many moments to judge its outcomes against its ambitions and promises.