The three large truths about the Affordable Care Act

Having failed to defeat the Affordable Care Act every other way, Republicans are now hell-bent on destroying it in Americans' minds.

Every Republican in Washington has been programmed to use the word "disaster" whenever mentioning the Act. The idea is to make it so detestable it becomes the fearsome centerpiece of the midterm elections of 2014.

Admittedly, the president provided Republicans ammunition by botching the Affordable Care Act's rollout. But the president and other Democrats should be stating and restating three larger truths that show the pettiness of the Republican attack:

Our health-care system was a wreck. Ours has been the only health-care system in the world designed to avoid sick people. For-profit insurers have spent billions finding and marketing their policies to healthy people while rejecting people with pre-existing conditions, and routinely dropping coverage of policyholders who become seriously sick or disabled. What else would you expect from corporations seeking to maximize profits?

The social consequences have been devastating. We've ended up with the most expensive health-care system in the world (finding and marketing to healthy people is expensive, corporate executives are expensive, profits adequate to satisfy shareholders are expensive), combined with the worst health outcomes of all rich countries -- highest rates of infant mortality, shortest life spans, largest portions of populations never seeing a doctor and receiving no preventive care, most expensive uses of emergency rooms.

We could not and cannot continue with this travesty of a health-care system.

The Affordable Care Act is a modest solution. It still relies on private insurers -- merely setting minimum standards and "exchanges" where customers can compare policies, requiring insurers to take people with pre-existing conditions and not abandon those who get seriously sick, and helping low-income people afford coverage.

A single-payer system would have been simpler and more efficient. (It's no coincidence that the Act's Medicaid expansion has been easy in states that chose to accept it.)

But Republicans wouldn't even abide a "public option" to buy into something resembling Medicare. In the end, they wouldn't even go along with the Affordable Care Act, which was based on Republican ideas in the first place.

We owe it to each other. The Act depends, fundamentally, on a social compact in which those who are healthier and richer are willing to help those who are sicker and poorer. Such a social compact defines a society.

The other day I heard a young man say he'd rather pay a penalty than buy health insurance under the Act because, in his words, "Why should I pay for the sick and the old?" The answer is he has a responsibility to do so as a member the same society they inhabit.

The Act also depends on richer people paying higher taxes (a surtax of 3.8 percent on their capital gains and dividend income and a nine-tenths of 1 percent increase in their Medicare taxes) to finance health insurance for lower-income people.

Here again, the justification is plain: We are becoming a vastly unequal society in which most of the economic gains are going to the top. It's only fitting that those with higher incomes bear some responsibility for maintaining the health of Americans who are less fortunate.

This is a profoundly moral argument, but Democrats have failed to make it, perhaps because they're reluctant to admit that the Act involves any redistribution at all.

It's easier to say everyone comes out ahead. And everyone does come out ahead in the long term: Even the best-off will gain from a healthier and more productive workforce, and will save money from preventive care that reduces the number of destitute people using emergency rooms when they become seriously ill.

But there would be no reason to reform and extend health insurance to begin with if we did not have moral obligations to one another as members of the same society.

The initial problems with the rollout are trifling compared to the wreckage of the current system, the modest but important step toward reform embodied in the Act, and the moral imperative at the core of the Act and of our society.

Republicans have created a tempest out of trivialities. It is incumbent on Democrats -- from the president on down -- to show Americans the larger picture.

Robert Reich, former U.S. Secretary of Labor, is professor of public policy at the University of California at Berkeley and the author of "Beyond Outrage," now available in paperback. His new film, "Inequality for All," was released in September. He blogs at

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