On the road to single-payer

Republicans find themselves in a gargantuan political and policy mess over health-insurance reform for two primary reasons. First, they overpromised – vowing to repeal and replace Obamacare without a plan in hand that they knew would be well received by the public. Second, they dared to disregard the fact they can’t out-Democrat the Democrats – that is, it’s difficult for GOP leaders to get their caucus fully behind all-encompassing legislation, as the Democrats did in enacting the Affordable Care Act.

Democrats were able to push Obamacare across the finish line in 2010 because they possessed that rare combination of political will and electoral muscle. They controlled the House, Senate and White House, thanks to the onset of the Great Recession in the final months of the George W. Bush administration. And they were unified. There were moderate Democrats who feared Obamacare was too extreme, and far-left Democrats who thought it didn’t go far enough – but when it came time to vote, they played as a team. This summer, at least four Republicans decided the Senate health-insurance bill isn’t good for the United States, or for their own re-election prospects. So they’re playing for the other team – hurting the GOP’s political prospects, but presumably acting in what they perceive as the best interests of their constituents.

Arguably, the best approach for Republicans would be to recall why they opposed Obamacare in 2009 and ’10.

In 2009, an estimated 16.2 percent of Americans had no insurance coverage. The rest were covered by insurance policies through their employers; Medicaid; Medicare; non-group policies; and other public coverage. That accounts for a whopping 84 percent of Americans. And no one actually was denied health care. Hospitals were, and are, obligated to treat people when they show up with illness or injury, regardless of their insurance status.

In other words, health insurance was a problem for a relatively small percentage of Americans. The poorest people were, and are, eligible for Medicaid. A large percentage of the uninsured were healthy, young, working people – uninsured by choice, not poverty or inability to tap into public, private or employer-provided insurance.

To put it bluntly: The problem of uninsured Americans could have been solved, or at least controlled, by much less ambitious means than Obamacare – or, for that matter, the Senate Republicans’ Better Care Reconciliation Act of 2017. It still could be, but Congress – and not just the Democratic Party – has a more ambitious vision.

In short, Obamacare was and is a bridge to single-payer health insurance – government-controlled health care. The plan devised by Senate Republicans added a few abutments and girders to the Obamacare bridge: “The GOP plan … would have been more of an express route to single-payer than Obamacare ever was,” Holman W. Jenkins Jr. wrote in his July 19 Wall Street Journal column, “The Result of GOP Failure.” That failure, to be sure, extended the bridge to single-payer health insurance a few more yards.

Americans who are aghast at the Charlie Gard saga playing out in Great Britain – where bureaucrats, not parents or patients, make life-or-death decisions – will live to see the day when the same rules apply in the United States.

Unless the GOP can come up with a repeal-and-replace scheme that’s so perfect, that a few Democrats will discern its public and electoral benefits, and cross the aisle.

We dare to hope for that dream to come true, but only a fool would predict such an outcome.

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