For what might very well be the last swing and miss at it, Senate Republicans once again attempted, in vain, to pass an ACA “repeal and replace” bill last night, but failed due to opposition from Susan Collins, Lisa Murkowski and John McCain.
While it was easy to rail against Obamacare for seven years as a minority party, and hold meaningless votes to repeal the law, secure in the knowledge that Obama would veto their efforts, the real down and dirty nitty gritty of passing a viable replacement bill simply eluded the party once it seized the levers of control.
The reasons for that failure are apparent: every single effort they made would have resulted in literally tens of millions of people losing their coverage, and would have vastly increased the costs of coverage to the most sick and vulnerable populations, only offering affordable policies to young, healthy people – and those policies would have covered next to nothing, making them a worthless product for the consumer and a cash cow for the already bloated insurance industry. These factors and many other unsavory features of the GOP “replacements” – the elimination of coverage for preexisting conditions, the elimination of the requirement that employers provide health insurance – made for legislation that, while only a few votes away from passing, set records for public disapproval.
Additionally, there was no leadership from the White House on the issue. Whereas Trump promised during his campaign to “take care of everybody” with something better and cheaper, that promise evaporated promptly in office, as Trump delegated the task of crafting a reform bill to Paul Ryan, who has fundamental ideological resistance to government healthcare to begin with. That didn’t matter to Trump – he clearly would have signed anything that landed on his desk. He wanted only the political victory of saying he erased another one of Obama’s accomplishments, and he didn’t give a damn what the bill actually did. Even after it somehow penetrated his consciousness that the House bill was “mean”, he was still completely on board with it if it could pass.
The fundamental reason for this massive fail, though, is the fact that “Republican healthcare” is an oxymoron. The Republican Party doesn’t care about providing a safety net in the healthcare arena beyond what existed before Obamacare, and in fact they’d like to get rid of that too, if they could. As Jesse Berney points out in Rolling Stone: “They don’t believe access to health care is a basic human right. They don’t believe people should never go bankrupt because they get sick. They hide behind words like “freedom” and “personal responsibility,” but what’s freedom worth if you get cancer while making $30,000 a year? How can anyone who isn’t fabulously wealthy be expected to take personal responsibility for bills that could easily go into the hundreds of thousands, or even millions, of dollars?”
Republican faith in the free market to solve all our problems doomed any attempt at writing a health care law. The free market doesn’t care if people get sick, go bankrupt or die if there’s no profit in it. The Affordable Care Act was a last-chance effort to preserve a market-based health care system, based largely on ideas that originated in conservative think tanks – Republicans routinely ignore the fact that its overall shape was dictated by a proposal from the conservative Heritage Foundation. Its failures are mostly due to too little regulation, not too much (think of price caps on certain drugs or services, or the ability to negotiate pharmaceutical prices in bulk). The plan Republicans have been fiercely opposing because it has a black president’s name attached to it was as close as conservatives ever got to a GOP healthcare plan.
We now know, without any doubt, that anything that Republicans are going to come up with will take coverage away from people, and every single bill they offered up was condemned even by the health insurance industry because the proposals simply weren’t workable: by getting rid of the individual mandate and doing nothing to ensure participation in the risk pool, coverage would have to be drastically restricted, or premiums drastically raised.
Unsurprisingly, it turns out that’s not what Americans want. Americans don’t want to be kicked off their health insurance, or to have it become unaffordable, or to fail to cover our actual needs. Yet the fact that every single Republican “replacement” for the ACA failed these tests is a telling one.
The fact of the matter is that we are, inevitably, on a road to universal coverage of some sort, whether single payer or not. And with good reason: our present system has some of the highest costs for care in the world, with substantially worse outcomes for those high costs than is the case in any system which provides universal healthcare to its citizens. And indeed, we are alone in the ranks of industrialized nations in not providing universal healthcare. Healthcare systems which operate on principals of universal coverage for all citizens consistently deliver results which are superior to those of our own system in every single metric: in terms of costs, clinical outcomes and, above all, from a moral standpoint.
The free market doesn’t care if people lose insurance, or if people die. It cares only if there is money to be made from them. By creating a vast, self-interested middleman system, our private health insurance-based regime fails the intended beneficiary on every score. The only system we cannot afford is the one we presently have. And there may be kicking and screaming, and a great deal of resistance from the stakeholders in the present system, but the outcome of last night’s failed repeal and replace vote places us firmly on a road to universal coverage. It is inevitable, because practicality dictates that it must happen sooner or later. We are the only world power which has not learned this and accepted it.
We are in the middle of what is likely a 50-year cycle of healthcare reform. If we consider “Hillarycare” in 1993 as the beginning of our current arc, we are already halfway there. The path of history inevitably points toward progress. But we will have to move beyond our current national nightmare to see further progress.