And so with ukuleles and autoharps, and cheers and groans, Americans usher Obamacare onto the public stage, knowing – with hope, with disgust, with fear, with acceptance – that the thing is here to stay, in the way all government programs, once enacted, hang around like a deadbeat brother-in-law: chain-smoking, impossible to get rid of.

Foes and friends of Obamacare understand this truth: You never get rid of a government program. Did Ronald Reagan, despite vows and expectations, ever get rid of the promiscuous and worthless Department of Education? Or the Department of Energy? Hardly. In like-manner, Obamacare will endure. The government already claims 1.1 million sign-ups. It is below original expectations; each one nevertheless represents an aspiration not even a President Cruz would find possible to repudiate. And more sign-ups are to come.

The monstrosity won’t deliver its products efficiently. It will cost more than taxpayers can afford. It will overload particular hospitals and physicians while short-potting others. It will mechanize the delivery of care: less human attention, more bureaucratic decision-making. It will likely discourage various people from becoming doctors, or from continuing in medical practice. No wonder majority opinion, as reported by the polls, rejects the whole thing.

But it will endure. That’s partly because it will serve people who consider themselves underserved, and in many cases may actually be. People who like a particular government “service” become loud and articulate advocates for it, outshouting less-passionate opponents. Moreover, a government structure, once erected and financed and fully staffed, becomes too large a thing to clear away and replace.

Obamacare will endure, but maybe in a form less harmful to civic, as well as personal health. That’s the hope as 2014 brings to us the greatest change in our governmental culture since the Great Society.

Upon the brains and leadership of the Republican Party – highly uneven commodities – rest all realistic hopes for change. You see what a dicey business this will be on account of the utter lack of a Republican approach to change. “Repeal and replace” rolls off the tongue with great readiness – not to mention effrontery. It doesn’t get us past the bill title. There’s nothing like a “Republican plan” to deal with Obamacare: not least because nobody can yet know what kind of plan to propose.

The “what kind” part will depend on developments yet to develop. All we know at present is that theory and concept are at odds with general experience in that they put the government in charge of the whole thing with only modest scope for personal decisions (e.g., a bronze, silver, gold, or platinum plan). Not until clients (bondservants?) of the system start to put its requirements into effect will anyone know what needs to be done. Plans and proposals can then come into play.

This is a sorrowful message to deliver at the start of a new year. It happens, alas, to agree with experience. What will be fundamental to reform is introducing into the system as much change as it can accommodate. This is because programs built on the theory of “one size fits all” – the only theory the federal government recognizes – are costly and don’t work. One size doesn’t fit all, the less so when health needs are involved. There has to be room in any post-Obamacare program for people to explore their own needs and pick and choose among opportunities of the sort no overstuffed bureaucracy could ever devise.

There is one more point to keep in mind. This ghastly mess is due to our 80-year-old habit of reliance on government for solutions to perceived problems. Every time we conjure up government, as opposed to free-market, solutions to this or that, the habit grows larger, deeper, harder to shake.

Eighty years of government “problem-solving” has put Americans in the relaxed mood that gave us Obamacare. Let government do it! So the cry goes out regularly, monotonously at the slightest provocation.

Do we start to appreciate how we got into this – assuming we’re lucky – partly fixable fix?

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