At dinner Friday night in a beautiful little town on the Massachusetts seacoast, I shared the table with a self described arch conservative, and did my best to enjoy my meal while listening to him rage against the evils of the ACA. Knowing that he has a small business in the state and 2 children their early 20s, I politely inquired whether he takes advantage of the components of the Massachusetts health care law (aka Romneycare) that work to his advantage. He answered, "I know its hypocritical, but yes of course I do."
Like a thunderbolt it hit me. American hate the ACA because the vast majority of them (>80%) already have pretty good health care, and they see the law, correctly, as a benefit for those who don't. For the adequately insured, (and I include Medicare recipients in that category), the ACA offers no particular advantage. When most Americans ask "What's in Obamacare for me?" the answer for most of them is "Nothing, except your tax dollars will have to pay for it."
Roosevelt understood the critical intersection between self interest and societal interest when he insisted that Social Security benefits would be extended to all citizens whether they needed them or not. Otherwise, he correctly foresaw that Americans would come to see Social Security as a welfare plan and resent it as a giveaway to the undeserving (i.e not them).
But as Obamacare passes into history, either via Supreme Court rejection or repeal by a Republican Congress in 2013, policy makers would do well to remember the flip side of a politics based primarily on perceived self interest. For if we don't like someone else benefiting from the government's largess, we will scream like an enraged 2 year old when the goverment takes away something from us that we already have. Republicans understood this completely when they portrayed the ACA as "taking away away your Medicare" a program they would like to dismantle. So be careful President Romney. Go ahead and try to "reform" Medicare outside of the framework of comprehensive tax reform and deficit reduction. I double dog dare ya.