Bachmann and Gingrichâ€™s comments [at the Republican presidential debate]â€”ridiculous though they areâ€”reflect an uncomfortable reality. Politically speaking, President Obama now owns two of the biggest systemic problems in America today. He obviously owns our economic predicament. Somewhat less obviously, he owns our health care financing and delivery predicaments, too. ACAâ€™s main pillars wonâ€™t be implements until 2014. Yet if insurance premiums rise, blame health reform. If the number of uninsured rises, blame health reform. If experts say that particular cancer screening test is less valuable than you were hoping it would be, blame health reform.
Everything that people find discomfiting about evidence-based medicine, about rising health care costs, about the inherent uncertainties of new medical interventions and diagnostic technologies, about the tragic dimensions of end-of-life careâ€”each of these things becomes yet another reason to dislike the new law.
This isnâ€™t fair or logical. Actually, itâ€™s very stupid. Itâ€™s where we are. Donâ€™t expect Republicans to hold adult political conversation about such matters until Barack Obama has left the presidency.