REFORM, NOT REPEAL:

Reforming the health-care system is an inherently daunting project. What makes health care so resistant to change is that, the worse the system gets, the harder it is to change. More waste means more profit centers with an interest in protecting their income. And more uninsured people means more anxiety for those who do have insurance about losing it, and hence more resistance to change. The political miracle of Obamacare was its ability to design a way to cover the uninsured and to pay for the coverage in a politically viable fashion. The law found a way to solve a political problem that had frustrated would-be reformers for decades.

And they accomplished it against the ruthless opposition of a united party that has used every demagogic method to undermine it -- in Washington, in the states, and in the courts. If Republicans had not launched a legal battle to allow states to deny Medicaid coverage to their citizens, and then cruelly taken up the opportunity to do so; sabotaged small but crucial risk-corridor payments to encourage insurer participation; and denied funds for outreach to exchange customers, it would be functioning better than it is. Still, it is functioning. As the Congressional Budget Office found last week, the exchanges are not in a death spiral. Insurers have found a stable price point.

Republicans have spent eight years fooling themselves about Obamacare. They have built a news bubble that relentlessly circulates exaggerated or made-up news of the law's shortcomings and systematically ignores its successes. The smartest members of the conservative-wonk set played a more clever game to retain their influence. No serious conservative analyst could argue that Obamacare had actually made the health-care system worse. How could they, when the federal government is now spending less money on health care than it was projected to spend before Obamacare passed, medical inflation is at the lowest level since the government began recording it 50 years ago, and 20 million more Americans have insurance? But admitting Obamacare constituted an improvement in the health-care system, even an imperfect one, would be tantamount to expulsion from the conservative movement, and with it any hope of influencing Republican policy. The closest they might come is pleading that repealing Obamacare was "not enough," that they must also replace it with something better.

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