Opponents of President Obama's health care legislation were wise to attack it preemptively in the courts on constitutional grounds.
If they hadn't attacked now, they would've learned that universal health care systems – sometimes a hybrid of public and private and sometimes single-payer national systems – are wildly popular in other countries.
So popular that politicians can do no more than fiddle at the edges, as they've done in Britain recently and are about to do in France. No leader, not even that incontrovertible defender of private enterprise, Margaret Thatcher, dared -- or even thought -- to privatize health care.
In the industrial democracies, from Canada to Japan, people complain about their health care systems and would defend them to the death. Once universal health care is introduced and people are relieved of the fear of illness, leading to financial ruin, it's unrepealable.
The opponents of Obamacare must know this, or they wouldn't have been so anxious to test it in court on the grounds of the constitutionality of the individual mandate. Kill it before people love it was an imperative.
Now it's widely believed, after three days of hearings, in which conservative justices sounded more like they were conducting a congressional hearing than a judicial one, that Obamacare will be thrown out before it has ever been sampled by the public, which wouldn't come until 2014. It's been a bit like the Chinese and democracy: Don't let them try it, they might like it.
So how is it the Republicans have been able to so demonize Obamacare? Partly, it's because the administration has done an appalling job of selling its own program. It's almost as though it's ashamed of its offspring because it isn't the child they really wanted: a simpler bill with a public option, and such goodies as interstate insurance sales.
The administration is frequently bad at trumpeting its achievements. As health care reform is its defining domestic issue, the fact that Obama and his cabinet have not extolled the virtues of the bill amounts to a curious dereliction, a sin of omission.
Most people have been persuaded, if they know anything about the bill at all, that it's socialized medicine (it is not); that it will double expenditures on health care (it won't); that it's an enormous new dictatorial intrusion into individual liberty (it's not).
It's not a great bill, but a good start.
We in the United States spend about twice as much as other countries on health care – about 18 percent of our gross domestic product.
Why? Everyone knows there's excessive testing and waste. The quick answer is to defend against lawsuits. Another answer is that doctors have no incentive to save money and through their investments in testing companies, often they have an incentive to order up the tests.
Mostly, I suspect it's just indifference; the medical equivalent of not turning the lights off.
I don't like Obamacare because it only does half the job, and I'm uneasy about the individual mandate. Just two cheers from me.
The uninsured should be assigned an insurer and the premium collected through the tax system; that way the insurers would compete for the most desirable prospects -- young adults -- and a real pool would operate.
Another question that isn't asked: As new technology usually brings down costs, why does this not apply in health care? Why are CAT scans and MRIs not getting cheaper, as they would if they were in a different framework?
Why not use the Republican idea of health vouchers as an incentive to keep patients from frivolous use of services – not as the substitute for insurance, but rather as an incentive mechanism. Pay them to stay healthy.
We suffer from a failure of imagination in health care.
There are good reasons to be ambivalent about Obamacare, but it's a start, a building block. Our medicine is without peer, but our concepts of care are quite sickly.