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.
It didn't attract Republican support but near-unanimous Republican opposition. The president's mistake -- one of them, anyway -- was failing to see that he had borrowed ideas Republicans were eager to get rid of. By the time he arrived in office, they had lost interest in making citizens buy insurance, even to minimize public burdens.
Or maybe the GOP had simply lost interest in addressing the problem that motivated Democrats: the lack of health coverage for some 40 million Americans. It was not merely their problem, since almost all hospitals are required -- under a 1986 federal law signed by Ronald Reagan -- to provide emergency care to patients regardless of their ability to pay.
But the individual mandate, conceived as a way to force potential freeloaders to take responsibility for themselves, was a bridge too far for conservatives. They saw it as a huge federal violation of personal autonomy, as well as an unprecedented and unconstitutional assumption of power.