There's a certain rational philosophical argument to be found in opposition to the Affordable Care Act if you really believe in a smaller federal government.
It's that if people increasingly see health care as a fundamental government function, then government's involvement will never go away.
But the federal role in assuring medical care for millions of Americans was already extensive before Congress passed health insurance reform this year. And despite all their saber rattling about dismantling the law, surely Republican leaders don't have the support, the will or the better ideas to change that.
When the Republicans controlled not just the House but also the White House, they didn't shrink Medicare, the program that insures 39 million senior Americans -- no, Republicans twisted arms and manipulated voting procedures to add a prescription-drug benefit expected to cost $500 billion over a decade, which even some Democrats said we couldn't afford. How's that smaller government?
Now it seems Republicans want to investigate provisions in the new law designed to save billions of dollars in Medicare and make the program more efficient. Isn't that what Republicans, like all of us, want to see from government: better use of our money?
When Republicans had all the power, they could have made a powerful gesture to underscore their supposed disdain for all things "socialist." But have they ever -- ever -- considered relinquishing the generous government-administered health insurance benefits that taxpayers provide them through their employment on behalf of the American people?
"If you think it's a socialist plot and it's wrong, for goodness sakes, drop out of the Federal Employee Health Benefit Program," Democratic Sen. Dick Durbin of Illinois helpfully invited his Republican colleagues recently.
It was great political grandstanding -- and a video clip was conveniently posted on YouTube -- but it also raised a valid point: Government programs are good for the haves but not for the have-nots?
Every time I hear the Affordable Care Act derisively called "Obamacare," I get mad. Candidate Barack Obama promised health insurance reform, and President Obama pushed for it and, yes, took credit for the resulting law. But he didn't dictate what would be approved by members of Congress, whom I guess we're supposed to consider merely his puppets and automatons. He was even disparaged for his early disengagement from the drafting process.
Members of Congress decided the parameters -- Democrats, yes, but they, too, were elected by the people. And surely it's a fiction that "a majority" of Americans didn't want the law and don't like it. Were that so, it never would have passed.
No doubt many people don't like being required to buy health insurance -- even many who already do and would continue to do so anyway.
But who prefers the old status quo: many of the uninsured seeking treatment in emergency rooms, where it's more expensive, resulting in costs being shifted to those who are insured through higher premiums and ridiculously expensive hospital bills?
Of course, another alternative is that the uninsured sick simply don't get treated and get worse, suffer needlessly or pass infectious diseases to those around them. Surely that's not the trade-off we're going to insist on for smaller government.
What many Americans really don't like is having the government tell us to do things we don't want to be told to do.
We might not want to be told to buy health insurance, but we sure want the government telling drug companies not to poison us.
We might not want to be told what we can eat, but we sure want the government telling meat plants and poultry manufacturers and egg suppliers not to sell us food that could kill us.
The Affordable Care Act has its flaws. And though it aims to insure 32 millions more Americans, I fear that predictions about its many other anticipated benefits are probably overly optimistic.
But if the law helps improve Americans' health through preventive care, reduce the number of families bankrupted by catastrophic medical bills and use research to make treatment safer and more effective, how is that not progress?