Economist Bryan Caplan has some interesting thoughts, starting with a depressing and probably accurate observation about why bad government programs have to be strangled before they occupy the crib:
If history is any guide, all Democrats need to do to ensure permanent bipartisan support for Obamacare is pass it….
Notice: In other areas, especially foreign policy, things don't work this way. Bush II invaded Iraq and winked at torture; Gore probably wouldn't have. Clinton invaded Haiti; Bush I probably wouldn't have….
….politicians often have some political slack—a range of electorally safe options….Slack exists insofar as the median voter is roughly indifferent……Politicians can safely do A instead of B as long as voters are—out of apathy or deference—indifferent between them.
OK, so what's the difference between health policy and foreign policy? For health policy, the median voter has fairly specific preferences. He knows he likes giving free medicine to the American elderly, he knows he hates rationing, and he knows he doesn't want to listen to fiscal Cassandras. Hence, the political juggernaut that is Medicare. For foreign policy, in contrast, the median voter has a big range of indifference. If the President says we need to invade Iraq, he'll go along with it for a couple years at least; if the President says Iraq isn't a problem, the median voter will go along with that, too.
Bottom line: Libertarians should fear government-run health care no matter who's in charge. For liberals, however, it doesn't make much difference. As long as public opinion is firmly on your side, it doesn't matter who runs the government….
That matter of public opinion and its shaping is why the endless work of advocating and arguing in the public square (or the public Internet) for one's political values, whether or not its effects can be quickly quantified, is so important.