I certainly don't think Obamacare will work. The program is a mess. But Kirch and Akston are dead wrong on the political consequences. When I taught college I included in my lesson something called the "Iron Triangle of Bureaucracy." Wikipedia actually has a good description of the concept:
In United States politics, the iron triangle is a term used by political scientists to describe the policy-making relationship among the congressional committees, theThe idea of the iron triangle is that concentrated political power in the triangle almost always defeats diffused political power outside the triangle. Any government program that is created, even a bad program, develops a constituency of individuals and businesses who benefit from it. That constituency represented by the tree vertices of the triangle has concentrated political power. The program is critical to them and they will do whatever it takes to keep it going. They will vote on the issue, they will donate money based on the issue, they will lobby based on the issue.
For example, within the federal government the three sides often consist of: various congressional committees, which are responsible for funding government programs and operations and then providing oversight of them; the federal agencies (often Independent agencies), which are responsible for the regulation of those affected industries; and last, the industries themselves, as well as their trade associations and lobbying groups, which benefit, or seek benefit, from these operations and programs.
At one corner of the triangle are interest groups (constituencies). These are the powerful interests groups that influence Congressional votes in their favor and can sufficiently influence the re-election of a member of Congress in return for supporting their programs. At another corner sit members of Congress who also seek to align themselves with a constituency for political and electoral support. These congressional members support legislation that advances the interest group's agenda. Occupying the third corner of the triangle are bureaucrats, who are often pressured by the same powerful interest groups their agency is designated to regulate. The result is a three-way, stable alliance that is sometimes called a sub government because of its durability, impregnability, and power to determine policy.
Consumers are often left out in the cold by this arrangement. An iron triangle can result in the passing of very narrow, pork-barrel policies that benefit a small segment of the population. The interests of the agency's constituency (the interest groups) are met, while the needs of consumers (which may be the general public) are passed over. That public administration may result in benefiting a small segment of the public in this way may be viewed as problematic for the popular concept of democracy if the general welfare of all citizens is sacrificed for very specific interests. This is especially so if the legislation passed neglects or reverses the original purpose for which the agency was established. Some maintain that such arrangements are consonant with (and are natural outgrowths of) the democratic process, since they frequently involve a majority block of voters implementing their will through their representatives in government.
The folks outside the constituency, members of the public, have diffused political power when it comes to the issue. While it might be important to them, it is not nearly as important as to those in the triangle. Further, their opposition is very disorganized. Even though much greater in number, those outside the triangle do not have the political clout necessary to scale the mountain to dislodge the government program.
As an example, there was a Board of Tea Appeals, consisting of seven people, each of whom was to be an expert on teas. Those experts were to prepare and submit to the Secretary of Health and Human Services standard samples of tea. Wikipedia describes the Board's activities:
In accordance with the board of experts' recommendations, the Secretary was instructed to "fix and establish uniform standards of purity, quality, and fitness for consumption of all kinds of teas imported unto the United States" and to deposit samples of these standards in the customhouses of various ports of entry. Tea importers were required to submit samples of their product for comparison with the standard samples kept at the customhouses. The imported samples were then tested "by a duly qualified examiner," who would test "the purity, quality, and fitness for consumption of the... [imported tea samples] according to the usages and customs of the tea trade, including the testing of an infusion of the same in boiling water and, if necessary, chemical analysis."The Board remained in existence despite the fact that the FDA already regulated the quality of tea imported to the United States under the Federal Food, Drug and Cosmetic Act of 1938.
The statute declared it unlawful to import into the United States "any merchandise as tea which is inferior in purity, quality, and fitness for consumption to the standards [kept at customhouses..." For nearly a century, Congress provided that no imported tea could enter the United States unless federal tea-tasters decided that it measured up to preselected standard samples....
The 1897 legislation that had created the Board of Tea Appeals was finally repealed in 1996. The Board remained in existence for 99 years, 58 years of which its work ws duplicated by another agency. Prior to 1996, there were numerous attempts to eliminate the board, which had received a great deal of publicity as an example of government waste. Yet year after year the constituency for the Board prevailed in keeping the program in place.
That is an example of how the Iron Triangle of Bureaucracy works to perpetuate even a tiny, unnecessary government agency. Imagine the power of the iron triangle that will be created by Obamacare. If Republicans think that implementation of Obamacare will propel them to political success they are sorely mistaken. Even if Obamacare fails to solve our health care problems, which it surely will fail, it will still succeed politically The Iron Triangle will make sure of that.