Republicans should step up to that, own it, advocate openly and vigorously for it, and accept the electoral consequences. But they won’t because they know what those consequences would look like. That is most emphatically 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 incredibly burdensome cost of health care in this country. (The U.S. health care sector is larger than all but five national economies in the world). So, for political survival, the GOP is left with cobbling together something that does what people want but which they can plausibly say is not Obamacare. But, of course, it will be Obamacare. Here is columnist George Will’s concise explanation of why that is:
“If you begin by accepting, as the country does, the Barack Obama premise that the chief metric of health care reform is universal access, and then if you add to that you’re going to have a system in which pre-existing health problems will not preclude you from purchasing insurance, and then you add to that you’re going to build this around a system in which 147-million Americans get their health insurance from their employer with special tax preferences for that…if you start like that you are bound to create a system of regulations and subsidies that’s very complicated; different regulations than Mr. Obama had and different subsidies, but the same basic kind of architecture.”
Noticeably absent from Republican deliberations on this matter, as they go about the business of assembling a program with the “same basic architecture” as Obamacare, are characterizations of it as “socialized medicine” and a government take-over of health care, both of which were flung around extravagantly during the original ACA debate. That debate, by the way, demonstrated that health care reform is not some pet cause of Democrats and lefties. Republicans and other conservatives were fully on board with the need for major changes in the way we provide and pay for health care. They – in the person of John Boehner, Mitch McConnell, Mitt Romney and many, many others -- said so repeatedly during the legislative debate over the ACA and have said so many times since. Although those people enthusiastically endorsed the idea that something needed to be done, what they thought that might look like they didn’t say. They only said Obamacare wasn’t it. For eight years.
No matter how many hairs Obamacare opponents try to split, Mitt Romney’s program in Massachusetts was, and is, essentially the same thing. So, they were for Obamacare before they were against it. The individual mandate was part of the Massachusetts program and was an idea that was strongly backed by conservatives whose position was that people who didn’t buy in would essentially be freeloaders. People who think the mandate can be cherry-picked out because it’s the one provision of Obamacare that everyone hates, don’t understand how insurance works. Paul Waldman of the Wasgibngton Post explains it this way:
“The ACA’s individual mandate wasn’t popular, but it was necessary to solve a key problem, which is that if you want to guarantee coverage for those with preexisting conditions, you need to spread costs as widely as possible. Get everyone into the risk pool, and you can do it. So the law required people to carry insurance, fining them if they don’t. The GOP plan says that if you maintain ‘continuous coverage’ then you’ll still be insured despite your preexisting condition. If you go without insurance for two months, then you’ll have to pay a penalty once you start getting coverage again. But you’ll pay it to the insurance company, not to the federal treasury.
“Here’s the thing, though. If you’re healthy, and especially if you’re young and healthy, this system actually incentivizes you to wait until you get sick before getting insurance. You can say, why bother with insurance now? Sure, I’ll have to pay a 30 percent penalty on my premiums when I buy coverage again, but only for the first year. If I can get away with 10 years of having no insurance, and only get it when I’m faced with high expenses, I’ll still come out ahead. If young people make that calculation en masse, the risk pool winds up confined to people who are older and sicker, premiums skyrocket, insurers flee and the whole thing collapses.”
The high cost of health care is a terrible problem, and the Obama administration, and before that the Clinton administration, were right in giving it high priority. It puts millions of Americans on the brink of financial catastrophe and/or deprives them of medical care altogether, it exercises undo influence over where and how we live and work and what we do for a living, and it sucks billions of dollars to itself at the expense of all other sectors of the economy. The ACA doesn’t directly address all of that, but can be seen as a start. Whatever else happens, the creation, passage, and implementation of it guaranteed continued and intensifying focus on this huge national problem. Obsessing over Obamacare, and distorting what it is and isn’t, is politically driven and does nothing to solve a problem many millions of Americans share.
Whatever the Republicans cook up, it will be Obamacare -- just a less effective version of it – one that many believe will lead to large numbers of people losing their health coverage and to increases in premiums and out-of-pocket costs. (There is speculation that House Republican are afraid the Congressional Budget Office will “score” it exactly that way, which is why they’re hustling the bill along so quickly, hoping for passage before the CBO can give them and the American people the bad news, and why they’re making remarks aimed at de-legitimizing the CBO and its work.)
Trump supporters: This will be the “something terrific” with which your man said he would replace Obamacare. He said, you’ll recall: “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”
Hmm.
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