The most striking thing about the Obamacare oral arguments was the absence of a moral argument in favor of universal healthcare. Liberals' quest to cover everyone spans almost three generations. They weren't pursuing universal coverage to grow government, increase efficiency, punish insurance companies, or "bend the cost curve." Their case was much stronger than that. As T. R. Reid put it in his book The Healing of America we have an "ethical obligation -- as a matter of justice, of fairness, of solidarity -- to assure everybody has access to medical care when it's needed." Instead of making that argument, Obama and liberal activists focused on overly wonky gibberish and ideological sideshows. In doing so, they deprived the final bill of the moral justification that might have blunted the arguments of its opponents.
When the healthcare debate began early in the summer of 2009, what's the first thing you remember? For me, it was the unfortunate phrase "bending the cost curve." After inheriting a deficit of $1.3 trillion, Obama apparently decided that he could only win the heathcare debate if he framed it as an exercise in long-term deficit reduction. He was not alone in this formulation. Healthcare policy wonks on both the left and right have long argued that the growth of healthcare costs was partly a function of our inefficient system, and that healthcare reform could be framed as an exercise as budgetary restraint.
Unfortunately, by focusing his initial public messaging on the flawed mechanics of healthcare markets instead of their inherent cruelty, Obama stripped away the moral urgency of his message and let his opponents demonize him without even being forced to admit his good intentions. People generally respect the intentions of so-called "bleeding heart" liberals whether they agree with them or not. Here we had a President proposing the largest program for the poor in a generation and spending all of his political capital on it, but very few on the Left or the Right ever said "at least his heart is in the right place." That's a failure in messaging.
Aside from his cold formuation of the issue, part of Obama's problem was that his liberal "allies" failed so miserably to focus the public's attention on America's inhumane healthcare system. Instead of concentrating on the millions who would benefit or the plight of those who might continue to suffer, liberals engaged in an obsessive (and ultimately pointless) crusade to include a public option as part of the healthcare plan. Rather than making the case for healthcare for all, liberals became fanatically obssessed with waging an ideological proxy battle over a small provision that would only impact a handful of people. The public option debate was nothing more than a proxy battle over the role of government. It's the kind of debate that Obama despises when he decries the "ideological battles of the past".
At some point, the Left forgot about the hardships of the uninsured and decided that the healthcare battle was about punishing private insurance companies for their past sins. I was often told, "We already compromised and gave up on single-payer and an end of private insurance. Why should we compromise again and give up on the public option?" I would answer, "The public option is an interesting idea. But there are people out there who are hurting and someone should be making the case for them instead of obsessing over this nonsense." That never worked. Obama had promised liberals a pony, and if they didn't get one, they were taking their ball and going home. Many liberals continue to (spitefully) argue that they wish that Obamacare never passed. They cling to their fantasy of American politicians' wiping out entire industries and creating a government-controlled system.
Liberals may be right in their contention that government health insurance schemes are more efficient than private insurance exchanges, but their obsession with the efficiency argument and hatred for insurance companies (who barely make a profit) distracted them from the moral case for universal healthcare. The public option might have lowered costs a bit, but it also might have served as a de facto dumping ground for the sick. Ironically, this would have enriched the insurance companies, who would be left in charge of a risk pool that tilted heavily toward the healthy. Either way, the provisions being considered only would have covered a few million people and never had more than maybe 45 votes.
The Left largely stayed on the sidelines during the Obamacare debate, instead choosing to spend their time throwing the occasional petty ideological temper tantrum. Obama's public messaging was cold, impassioned, and pedantic. The result was that Obamacare emerged from the legislative process with few passionate defenders, many enemies, and an unclear justification. If you strip away the moral case for Obamacare, you're left with 2,700 blank pages. The Left's opponents were more than happy to fill those pages with innuendo, feigned outrage, and their own ideological arguments.