And so with ukuleles and autoharps, and cheers and groans, Americans usher Obamacare onto the public stage, knowing -- with hope, with disgust, with fear, with acceptance -- that the thing is here to stay, in the way all government programs, once enacted, hang around like a deadbeat brother-in-law: chain-smoking, impossible to get rid of.
Foes and friends of Obamacare understand this truth: You never get rid of a government program. Did Ronald Reagan, despite vows and expectations, ever get rid of the promiscuous and worthless Department of Education? Or the Department of Energy? Hardly. In like-manner, Obamacare will endure. The government already claims 1.1 million sign-ups. It is below original expectations; each one nevertheless represents an aspiration not even a President Cruz would find possible to repudiate. And more sign-ups are to come.
The monstrosity won't deliver its products efficiently. It will cost more than taxpayers can afford. It will overload particular hospitals and physicians while short-potting others. It will mechanize the delivery of care: less human attention, more bureaucratic decision-making. It will likely discourage various people from becoming doctors, or from continuing in medical practice. No wonder majority opinion, as reported by the polls, rejects the whole thing.
But it will endure. That's partly because it will serve people who consider themselves underserved, and in many cases may actually be. People who like a particular government "service" become loud and articulate advocates for it, outshouting less-passionate opponents. Moreover, a government structure, once erected and financed and fully staffed, becomes too large a thing to clear away and replace.
Obamacare will endure, but maybe in a form less harmful to civic, as well as personal health. That's the hope as 2014 brings to us the greatest change in our governmental culture since the Great Society.
Upon the brains and leadership of the Republican Party -- highly uneven commodities -- rest all realistic hopes for change. You see what a dicey business this will be on account of the utter lack of a Republican approach to change. "Repeal and replace" rolls off the tongue with great readiness -- not to mention effrontery. It doesn't get us past the bill title. There's nothing like a "Republican plan" to deal with Obamacare: not least because nobody can yet know what kind of plan to propose.
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