Reality Eventuates

The Affordable Care Act, it now appears, will continue its painfully slow march toward full implementation in 2014. This has always been the essential problem: most of the good stuff that's going to happen to people won't happen until then, and that's why the opponents of the ACA have been able to rant about socialism and government takeover of health care and death panels. Once people see for themselves that nothing bad happens, game over.

However, as Timothy Jost discusses, it's going to take at least a few tweaks and also a few bucks for the ACA to really work out well. The right wing governors will have to accept the Medicaid expansion after all. Specific insurance regulations need to be promulgated (Stat!). The federal exchange needs to be set up because it appears several of the states are not going to establish exchanges out of pique. (Ideologically inconsistent, I know, to prefer federal control, but they aren't making sense about any of this to begin with.) The House Republicans will no doubt try to use extortion over the debt limit, the fiscal cliff, and federal appropriations in general to mess up the thing, whereas it actually needs some technical corrections and constructive changes.

Whether the Republicans can get away with, or think they can get away with, continuing their strategy of trying to wreck the society and the economy in the hope that the opposition will get the blame for their own vandalism, I don't know for sure. But it's looking right now like they think they can get away with it. A well-informed, honest journalistic estate dedicated to the public interest would probably stop them, but we don't have that. Look forward to the continuing hail of BS, and wish us all luck.