Any discussion of the Affordable Care Act cannot ignore the elephants in the room.
Republicans fought passage of what they call Obamacare in Congress and were outvoted. They challenged its constitutionality before the Supreme Court and lost. They made it their central issue in last year's elections and lost again.
Having exhausted all legitimate means for getting their way, Republicans resorted to extortion. Demanding that the nation's new health care law be "defunded," they forced a shutdown of the federal government. The shutdown put hundreds of thousands of people out of work, inconvenienced millions more and stopped vital services to some of America's most vulnerable people.
The GOP insisted that President Barack Obama "negotiate" to sabotage his proudest achievement, a 3-year-old law that a Supreme Court dominated by conservatives ruled was constitutional.
If Obama doesn't cave in, Republicans threaten to not raise the federal debt ceiling — in other words, refuse to pay bills that they already have rung up. The last time they did that, the economy suffered. If they do it this time, economists say, the results could be catastrophic.
This isn't just another partisan dispute or Washington gridlock as usual. It is an unprecedented act of hostage-taking by a minority party that doesn't seem to care who gets hurt.
For four years, Republicans have waged an ideological crusade against the health care reform law based on lies and distortions: death panels! Government takeover! They claim it will explode government deficits, even though nonpartisan analysts predict it will shrink deficits.
Gov. Steve Beshear wrote in The New York Times recently that Obamacare will, for the first time, make affordable insurance available to every Kentuckian. Currently, he said, 640,000 Kentuckians are uninsured.
Beshear also pointed out that a study by PricewaterhouseCoopers and the Urban Studies Institute at the University of Louisville found that expanding Medicaid as part of the reform law would add $15.6 billion to the state's economy during the next eight years and create almost 17,000 jobs.
The irony, of course, is that the new law is based on conservative ideas.
The philosophy behind Obamacare — requiring everyone to buy coverage from private health insurance companies — was first promoted by the far-right Heritage Foundation as an alternative to government health insurance. It combined market-based solutions with personal responsibility. But once Democrats embraced the idea, Republicans rejected it.
As governor of Massachusetts, Mitt Romney instituted just such a system. One reason Romney lost the 2012 presidential election is that he couldn't make a logical argument for why the health insurance system that has been good for Massachusetts would be bad for everyone else.
Republicans are desperate to stop the Affordable Care Act not because they are afraid it will fail. If that were the case, they would simply let it fail and then capitalize on that in the next elections.
No, the GOP's biggest fear is that Obamacare will succeed, just as Social Security and Medicare succeeded. Republicans opposed those programs when Democrats created them, and some factions of the GOP have been trying to undermine them ever since.
Republicans have tried to justify their extortion by claiming that Americans don't want Obamacare. But when asked about the things the law will do, opinion polls show, most people approve of it. And a substantial majority of Americans tell pollsters they oppose the Republicans' "defund Obamacare" crusade.
Many Democrats are dissatisfied with the new health care law because it doesn't go far enough. They think the United States needs a single-payer insurance system, much like Medicare, to provide universal coverage. It works for the elderly; why not Medicare for everyone?
Still, Obamacare is much better than what we have had. It will provide coverage to millions more Americans than were covered before, through more-affordable private insurance and an expansion of Medicaid for the poor (except in states where Republicans refused to accept federal funding for it).
One thing you will not hear from Republicans is a credible alternative to Obamacare for getting this nation closer to universal health insurance coverage. That's because they don't have one.