As the latest repeal-and-replace-Obamacare fiasco on the part of congressional Republicans fades into the mists at the end of Barack Obama's last fiscal year, it's worth reflecting on the main reason why the GOP, with unified control of all three branches of the federal government, has repeatedly tried, and repeatedly failed, to repeal Obama's signature accomplishment.
It's a phenomenally simple one: the false free-market ideology they have promoted for decades on this issue has come crashing into reality. Two realities, actually.
The first reality is that the law, left to work in the manner that it is supposed to, actually works. Despite repeated attempts by Congress in the last six years of Obama's administration to sabotage the functioning of the Affordable Care Act, more Americans now have health insurance than ever before. And, contrary to conservative predictions, the health care exchanges, national and state, have largely functioned as planned.
That latter accomplishment is being undermined by the Trump Administration, currently engaging in subtle (and not-so-subtle) efforts to undermine the exchanges in the hope that this will destroy the exchanges and make Democrats beg to negotiate with Trump on his terms. At the risk of being obvious about this, Trump's strategy puts him in violation of his constitutional obligation to ensure the faithful execution of the laws, and provides sufficient grounds for impeachment proceedings. That latter point, along with related ones, can and will be re-visited in a later post.
It's enough for now to note that most Americans have caught onto the fact that the ACA is a success. This is why Republican representatives and senators are terrified at the thought of holding town meetings with their constituents, who have gradually accepted a significant expansion of the so-called "welfare state" into their lives. In the process, they have come to accept the second reality to which I alluded earlier.
Very simply put, the go-it-alone approach to paying for health care doesn't work.
It may be enticing for some people to think that a health plan can be specifically designed for them, based on their very optimistic view of their short-term and long-term health prognosis. But that's the terrible thing about illnesses and injuries: they aren't trains that arrive at fixed stations on fixed timetables. The randomness of life guarantees that they can, with no warning, affect anyone, anywhere, anytime. Here is an example of a young man who learned this lesson the hard way.
This is why health insurance is not something that can be created and priced out like consumer goods. They only way to calculate the cost of health insurance with any degree is to do so using the largest potential number of consumers. And, whether insurance is public or private in nature, and whether the object is paying for medical care, or for the protection of other personal interests (homes, cars, earnings in case of death, and so forth), anyone with any experience in liability coverage will tell you that as the number of insured individuals goes up, the cost of ensuring each one of them goes down. That is because the fixed costs of health care can be spread out over an increasing number of individuals. And in what system do you have the maximum number of insured individuals?
That answer can also be simply put: single-payer.
Single-payer systems are working, even now, all over the world to ensure that the citizens of the countries using these systems are guaranteed coverage for their health care needs. Regardless of cost. Regardless of ability to pay. Regardless of the nature of the condition, or the circumstances under which it arose. Everywhere but in the United States.
Well ... there are some exceptions there, too. The U.S. does, in fact, have a single-payer system for the elderly, and the disabled. It's called Medicare. And, curiously enough, none of the GOP attempts to repeal the ACA have even attempted to touch it. They know what the rest of us know: Medicare is a form of single-payer that, like all other forms of single-payer, works.
As does the other system we have that is close to being single-payer, for the poor: Medicaid. In every state where the ACA's expansion of Medicaid was adopted, whether by a Democrat or a Republican government, it has proved to be enormously popular.
Is that why, in trying to repeal the ACA, the GOP tried to bribe one senator by saying that her state could keep it? Or why some conservatives were trying to include language in the last repeal-and-replace bill that would actually forbid states from establishing single-payer systems? So much for states as the laboratories of democracy; it turns out that there are some experiments that the GOP doesn't think you should be allowed to try. Even supposedly "reasonable" Republicans like Lindsey Graham have blatantly and unapologetically participated in this abuse of the legislative process--an abuse that threatens to pollute it entirely.
The free-market ideology of the Republican Party and the conservative movement generally has come crashing into the reality that single-payer coverage is the only form of health insurance that works. It doesn't matter that it deepens government involvement; it gives the people what they want and need--the ability to choose health care providers and services without worry about the cost. It's time for conservatives to get away from worshiping ideology and get back to what liberals and conservatives should be doing together: serving the needs of the people.
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