Smart Bombs: Despite objections, Obamacare has worked

The Affordable Care Act covers 1.6 million Floridians. Florida Health Choices covers 80.

The latter was pushed through the Florida Legislature in 2008 by then-House Speaker Marco Rubio. He told the Palm Beach Post back then, “It’s about competition, it’s about choice, and it’s about the marketplace.”

Today, it’s about dead.

Rubio is now a U.S. senator running for president and he wants to repeal Obamacare, as do all of his rivals for the GOP nomination. He would replace it with something that sounds like Rubiocare, even though it’s been proven to be a lousy way to expand health care coverage. Rubio isn’t alone in this regard. All the Republican candidates vilify the mandate to purchase health care and the subsidies for those who cannot afford the premiums. They say they want to replace the ACA. Just don’t ask for specifics. In the meantime, they parrot “marketplace,” “competition” and “choices.”

If they ever get to the point of laying out a detailed replacement, keep this question in mind: What is the goal?

They don’t like this question, because they know that without a mandate to purchase and the supportive subsidies, expanding coverage is practically impossible. So, instead, they skip past the goal and bash the current law while repeating the buzzwords. In their quieter moments, I suspect some are praying they don’t have to replace the ACA, because it would be politically impossible.

Love it, hate it or grudgingly accept it, the ACA is the only comprehensive health care plan aimed at non-elderly, uninsured Americans to ever pass Congress. Plenty of politicians have jawboned on the issue, but this is the only plan to have successfully run the formidable gantlet of competing interests and ideologies.

Many liberals, including me, would prefer a Euro-style system that provides universal coverage at lower costs without surrendering quality. It’s not clear to me what conservatives want. Greatly expanding coverage, however, is not a goal. Or if it is, they are woefully uninformed on how that’s achieved. Removing the mandate and subsidies is tantamount to kicking down the tent poles and expecting your coverage to remain aloft.

In any event, whatever liberal or conservative purists prefer would have to pass muster in Congress. Be honest. Can you see your desired plan collecting the needed votes? I can’t. So that leaves us with the ACA, as long as the U.S. Supreme Court doesn’t tamper with the subsidies.

The terrible, horrible, no-good scenarios foes have painted about the law have not come true. The U.S. economy is still here. In fact, it’s recovered from the recession better than any other first-world economy, despite lugging around the alleged albatross of Obamacare. Health care inflation did not soar; it has dropped. The deficit did not expand; it has contracted.

Furthermore, the individual insurance market has not cratered, as predicted. In fact, more and more insurers want to sell products on the government exchanges, which have created a marketplace with more choices and greater competition.

Can’t compete. If you’re wondering why health care reformers wanted a public insurance option – or why private insurers objected – a recent Wall Street Journal article helps explain.

Since 2007, Medicare and Medicaid (public insurance) have been more effective at containing health care spending than private insurance. Medicare spending per capita rose by 14 percent through 2013, and Medicaid spending rose by only 6 percent. Meanwhile, private spending rose by 29 percent, according to federal government data.

Rather than enjoying these savings, we can only dream about them.