The problem from the beginning with the GOP’s train wreck of a health care bill – a bill that got worse with each iteration, if that was possible – was that Donald Trump and Republican senators and congressmen never really knew or cared if the ACA was a good thing, a bad thing, or a thing in between. Their antipathy for Obamacare was never really about Obamacare. It was about their antipathy for Obama. And for anything of value for which Democrats could take credit.
So, for political survival, they were left with cobbling together something that purportedly did what people wanted but which they could plausibly say was not Obamacare. The result: a thing that was architecturally the same as Obamacare – and, for that matter, the same as “Romneycare,” the GOP-inspired program on which Obamacare was modeled -- but with provisions whose consequences, intended and unintended, helped no one and would have returned millions to the pre-Obamacare tender mercies of the insurance companies.
What Republicans should do (but clearly lack the stomach for) is stick to their religion and advocate for not only the repeal of Obamacare but for a complete and total absence of government involvement in health care. Get medical insurance from your employer, buy it on the open market, don’t get it all, but keep the government out of it. That is GOP orthodoxy and Republicans should advocate openly for it and accept the electoral consequences. But they won’t do that because they know what those consequences would look like. It’s not what the American people want. What they want is help – help from the government, which is to say help from each other -- in dealing with the outrageously burdensome cost of health care in this country.
Therefore, what Democrats should step up to is getting fully behind Medicare for all, and be willing to put that to the electoral test. That way, people who want zero government involvement in health care and people who want full government involvement will have a clear choice to make, and won’t have to settle for well-intentioned half-measures like Obamacare or malicious-intentioned ones like Trumpcare. As for those in the former group who worry about the taxes that will be needed to pay for Medicare for all, they should understand this: We are already paying that “tax.” We may not call it a tax, but whether it’s in the form of health insurance we buy on our own or higher prices charged by employers that buy it for us, it’s money leaving our wallets. Just like the money we pay to the tax collector, it’s money we have no choice but to part with. Either way, we’re gonna pay.
Meanwhile, the outlandish cost of health care continues to put millions of Americans on the brink of financial catastrophe and/or deprive them of medical care altogether, to exercise undue influence over where and how we live and work and what we do for a living, and to suck billions of dollars to itself at the expense of all other sectors of the economy. Given the demonstrated inability of the health industry or any outside actors to stabilize costs let alone bring them back to earth, the contention here is that including health insurance on the list of things we spend tax dollars on is therefore a not unreasonable idea. Why not “chip in” for health care? (And, no, it’s not “socialized medicine” or a government takeover of health care. The government would own no facilities nor employ any medical personnel. It would simply pick up the tab for insurance – as it already does, efficiently and effectively, with Medicare.)
No doubt, the underlying problem – the thing that drives all of these discussions and that makes insurance so pricey – is the cost of healthcare products and services themselves: practitioners, facilities, medicines, and all the rest. This is a mind-bogglingly complex problem with many moving parts, and it will not be solved by a magical stroke of legislation or an executive order from King Trump. The system is riddled with inefficiencies, unexplainable cost inconsistencies, duplication, non-standardization, fraud, and so on, and is remarkably resistant to the normal market forces that shape cost/price matters in other industries. A way to address all of this in a systematic way is elusive, but that’s what has to be done if the system is going to be tamed and prevented from having the excessive influence over the way we live our lives that it now has.
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