When I heard President Obama ask this question in the 2015 State of the Union speech I immediately thought of the pressing problem we have with reforming, replacing, or repealing the Affordable Care Act insurance exchanges. ACA exchanges is a dumb policy that is not only inefficient and cumbersome but it has split the American middle class into factions and turned ourselves against one another. It is an easy moral and political argument to make that ACA exchanges as a necessary policy to facilitate wealth redistribution between the rich and the poor. It is a completely different moral and political argument when the ACA is more accurately described as wealth redistribution amongst the middle class. That is how Professor Gruber, one of the architects of the Affordable Care Act, described it. As a healthy person in the middle class when I see higher health insurance rates I conclude that last year’s pay raise went to pay either someone else’s health insurance, protect insurance companies from bad government policies, or to help build a federal health care bureaucracy. It makes me bitter. As a healthy person I was not supposed to be affected by ACA reforms. Instead of stimulating the economy and creating jobs, increased health care spending is likely causing the middle class to hunker down. When I look at 21,000 pages of new regulations and rising health insurance costs, I think it is fair to describe the ACA as a deal made in political hell between between HHS, Democratic politicians, and insurance companies. It looks and smells like cronyism so it is not exactly the moral high ground that the middle class is likely to rally around. It is the second question he posed in the SOTU speech that goes to the heart of the reform, replace, or repeal debate. How do we recapture the sense of common purpose when the ACA has pitted middle class factions against each other? Is the ACA too morally corrupt to middle class sensibilities that reform is impossible or can we find some non-partisan reforms to make the ACA less evil?
Will we allow ourselves to be sorted into factions and turned against one another — or will we recapture the sense of common purpose that has always propelled America forward?
Many politicians believe that “America is great because America is good.” and “If America ever stops being good, it will stop being great.” Tocqueville attributed American exceptionalism to the fact their “morals can turn the worst laws to advantage”.
So how do we reform health care if America stops being good?