The Patient Protection and Affordable Care Act, aka "Obamacare," always suffered from lies, distortions and simple ignorance, and the Republican presidential debates continue the tradition.
Time has been the best thing going for the unpopular law. As one provision or another of the law kicks in, more people are conditioned to its benefits and discount the lies they have heard.
Last week, the Census Bureau's annual health survey reported that in the first quarter of 2011 more than 900,000 young adults obtained health insurance. They took advantage of a provision in the new health law allowing them to stay on their parents' insurance until they are 27. It was the first time in years that the share of young adults who were not insured fell.
The growth rate of Medicare spending, the issue that is driving the deficit-reduction war, is declining as hospitals and other providers react to the law's mandates to achieve efficiency and quality. The elderly poor and disabled are paying less for drugs under the overhauled Part D drug program and they will pay even less in January.
But the next best advantage to time may be the debates, that is, if many people other than the hard Republican right are watching. Every Republican candidate promises to ask Congress to repeal the law but none of them is equipped to say why the reforms should be stopped except for hollow generalities about government "interference" in medical care. You have to believe that halfway thoughtful listeners are beginning to suspect that the candidates don't know what they are talking about and that the scary scenarios they've heard for two years may be fictional.
And many surely have been horrified at what they have heard, if not from the candidates themselves then from the lusty Tea Party crowds that fill the debate halls.
Wolf Blitzer, the moderator of the Tea Party-sponsored debate, asked what the candidates would do, since they would repeal the law that will cover everyone, about a comatose 30-year-old who did not have or could not afford insurance. Would they let the person die? The crowd screamed "yeah."
None of the candidates wanted to answer the question, but Rep. Ron Paul, the pristine libertarian and the one thoroughly honest candidate, tried. People aren't dying for lack of care, he said, because someone is going to see that they get treated. He said the young man should have obtained insurance in advance. Paul said it was not the government's business to see that everyone was protected from the high cost of medical care. The private market and charity will provide.
Never mind that dozens of studies have shown that large numbers of people do die every year owing to lack of care or to treatment that was delayed because they were uninsured and could not afford the care.
A blogger was unkind enough to raise the case of Paul's 2008 campaign manager, the fund-raising genius Kent Snyder, who got pneumonia during the campaign and died two weeks after Paul ended his presidential race. Snyder could not get insurance because he had a pre-existing condition. He got care but left $400,000 in unpaid medical bills, which like tens of thousands of such cases will be passed along to insured people through higher premiums. Snyder's friends, including Ron Paul's staff, started a campaign to raise money to pay the bills but it shut down after collecting only $34,870.
Paul's advice that Blitzer's comatose young man should have insured himself would have been futile for his campaign manager. Every insurance company denied Snyder coverage. But starting in 2013, the month when one of the Republicans may become president, the Affordable Care Act will require insurance companies to insure people with pre-existing conditions.
Nearly all the debate exchanges on health care have been about Mitt Romney's Massachusetts health-care law, which was the template for the most controversial parts of the national law. Both require people to obtain health insurance, with some financial help from the government, or else pay a small tax or penalty.
Romney's pre-campaign book, "No Apology," boasts of his state's universal insurance law and suggests that something similar should be done nationally. The book came out in March 2010, three weeks before President Obama signed the Affordable Care Act. Romney revised the book for the paperback edition this year to remove the sentence about taking his health reforms national.
Will anyone but the unalloyed crazies believe that something that is very good for the people of Massachusetts and apparently popular will be bad for everyone else?
Halfway sentient viewers also would think there is something hollow about exclamations like Herman Cain's. Cain has opposed health-insurance reforms — all of them — for two decades because businessmen like himself might be pressured into helping pay for insurance for their employees. Cain, the winner of the Florida straw poll, said the other night that if "Obamacare" were the law he would have died two years ago because government bureaucrats would not have let him have surgery for colon and liver cancer.
Long before the first sentence of the Affordable Care Act was drafted, Republicans said it would allow government bureaucrats, not patients and doctors, to determine the care a person received. But nothing in the new law would prevent Cain's getting treatment or give a government bureaucrat authority to determine the treatment he receives.
Such nonsense would be laid bare in a real debate with someone who knows, like the president, but even in a chorus of true believers it rings hollow to anyone faintly interested in the truth.