I gritted my teeth and responded, and it seemed appropriate to document it here. Note that names have been scrubbed out of respect for a very bright and otherwise intelligent person.
[W]ith apologies (this is your crib here):
Here I go being a heretic again, but this is the question that most vexes me: where does the faith come from? Why, exactly, do people believe that this bill will actually help the little guy, instead of doing what every other bill in every other aspect of regulatory life has done since long before any of us were born: empower the politically connected at the expense of the not-politically-connected rest of us? Surely it's not simply because of the marketing and propaganda: does the assurance of a transparent Establishment shill like Krugman (and the NYT itself) simply make it so? None of this squares with history, which after all is nothing but an endless sequence of "reforms" that always, always, always seem to wind up worse than what inspired them in the first place. (We've been "throwing the bums out" since 1796.) Why do people keep lining up to do the same thing, and expecting different results? It's really hard to avoid the battered-spouse analogy here.
I'm putting aside, entirely, my principal objection to this racket, in order to point out that even for those persuaded by pragmatism, this thing has "lose-lose" written all over it. After more than a decade of the PATRIOT Act and what it has wrought (just for a recent and well-known example), I confess I just want to understand where the faith continues to come from.
Probably the best voice on this topic is the redoubtable Arthur Silber. He's about as far away from my own background as one could get, shamelessly self-referential, and unabashedly impolite in his directness, but what he is not is ill-informed or wrong. His work on this subject goes back well before the bill's passage, but his latest piece sums it all up quite nicely:
Seriously, for anyone who has the faith: why? What is it about this one that is going to be different than all that came before it?
UPDATE: In response:
Kevin - Where does the faith come from? I think it comes from that what we currently have is not working very well. Healthcare costs are astronomical, insurance is complicated, people who need insurance (e.g. preexisting conditions) find it hard or impossible to get. We are not SURE that this is going to work, but giving it a try could possibly improve things. The only thing that stays the same in life is change - yes, some reforms have failed, others have improved things (civil rights reform in the 1960s). We don't know until we try. For some reason the analogy of me in my first year of teaching keeps coming back to me: for example, in a certain situation what I'm doing is not working. So I try something new. It could turn out to be a disaster, it could be brilliant, or it could be somewhere in between. But at least I'm adapting to and thinking critically about my situation. In my opinion, the same thing applies here.
And to document my response:
To truly "do something different" you have to look at this with a bigger lens. There is nothing--nothing--about the system that we have now, the one that we all seem to agree is so unsustainably unworkable, that has not already been "fixed" many times over by legislation that was sold to us the same way, for the same reasons, and with the same result. The system which so badly needs repair now, is the very one that the Beltway Establishment has already given us. And so, as another product of the Beltway Establishment, ACA will perform just like all its smaller predecessors; we'll "discover", breathlessly, in time, that its construction is (surprise!) riddled with perfectly legal ways for connected cronies to make out like bandits at the expense of the politically unconnected--and it will do so in such a way as to provide the fuel for the *next* moral outrage that we "allow" some people to take advantage of others like that. Ten years down the road--or however long the cycle will take this time--the same gang will get everyone whipped up into another frenzy to "do something" because of how bad the system has by then become...and without a doubt they'll make sure that we are all well-informed as to what we can do to "reform" it: appeal to the same people, using the same political processes, affected by the same pressures...to achieve the same result. All the while, the little guy (that is, you and I) continues to get screwed.
Rinse, repeat. (Look into it seriously, and you'll discover that all politics works this way, from imperial warmongering to traffic tickets. Even sacred cows like "civil rights reform"; I would not want to try and defend the idea that we're any better off now, than then.)
If this way of thinking is rather contrary to everything you have been taught, you're hardly alone. I'm ashamed to admit how long it took me to recognize reality, but ultimately I just completely ran out of excuses and had to admit that in order to do something different, we'd actually have to do something different. This revelation requires that you be willing to let go of what you "know", for long enough to actually view it with a critical eye--and this is what most people are unwilling to do. The dual ironies in this are that 1) if what you "know" is truly better than an alternative, it would easily withstand the critical comparison, and 2) the only reason that political systems so vigorously persecute their heretics is that their moral imperative is easily destroyed by independent critical thought. (Like any protection racket, it's a survival strategy.) Consider the further irony that a common dismissal of political heretics is that they are somehow "paranoid"--for seriously considering an alternative.
It's not that we're not sure that this (ACA) is going to work. History suggests that we are sure that this is not going to work--unless by "work" we mean "further aggrandize the power of the state at the expense of the individual", in which case it will work beautifully, because that is what political systems do.
Most won't agree with me. Many have sortied forth with playbook ad hominem or smug dismissal. But nobody has shown me where this perspective has been proven wrong.
In the end, and despite the frustration, it's not my place or intention to "convince" anyone. I didn't respond to that either, when others were throwing arrows at what I "knew", and at any rate the reliability of an opinion achieved by browbeating is inherently suspect, isn't it?
I simply offer an alternative perspective. Keep it in mind as you watch how this plays out.
* Thanks, Claire, for stating that one like it is.