When it was enacted in 2010, Obamacare was supposed to be the final culmination of 60 years of effort by Democrats to realize the dream of universal health insurance. It was a complicated scheme, designed in such a way as to bridge the gap among Americans of different ideologies on how to address an alleged evil.
But dreams are rarely easy to bring into reality, especially when one person's dream is another's nightmare. Legislation that appeared to show the possibilities of compromise has ended up proving its limits.
Compromise is possible when two contending groups share a goal while differing on the means to achieve it. The problem in the realm of health care is that Democrats and Republicans don't agree on either one—or even, really, on whether a serious problem exists. Legislation passed with the bare minimum of popular support is inherently vulnerable.
It should be no surprise that neither side is particularly enamored of the program, since it reflected neither of their preferences. Democrats mostly preferred a Medicare-for-all system, with the federal government directly providing health care coverage. Barack Obama was one of them, though he eventually concluded it was politically impossible.
Instead he offered a public-private hybrid that preserved the existing private health insurance system while imposing new regulations, furnishing help to many to pay for it, and expanding Medicaid coverage.
He probably started out thinking this middle way would attract some Republican support. After all, its basic structure mirrored a 1989 proposal from the conservative Heritage Foundation. It was modeled on an overhaul adopted in Massachusetts at the behest of Mitt Romney.
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