So after ceaselessly decrying Obamacare, and multiple Republican attempts to eviscerate it with their depressingly hypocritical mantra to repeal and replace, the GOP finally controls both houses of Congress, the White House, and, soon enough, the Supreme Court. And yet, when finally in a position to repeal and replace, they come up with, to reprise George H. W. Bush’s famous criticism of Reaganomics as “voodoo economics,” Voodoo Healthcare 1.0. But alas, it is still far too liberal with the taxpayers’ money for the far-right House “Freedom Caucus” to stomach, and no Democrat is going to vote for actual repeal, so House Speaker Ryan’s Voodoo Healthcare 1.0 goes up in much deserved flames without even going to the floor for its inevitable No vote, much to the embarrassment of Republicans, the cheers of Democrats, and the usual whining of our Liar-in-Chief, Mr. Trump, who characteristically externalizes all blame to others, in this case the Democrats. Well gee, Donnie Boy, aside from the right-wingers who were poised to vote against it, did you really think that the party that passed Obamacare without a single Republican vote was going to suddenly have a Paul-on-the-road-to-Damascus experience and vote your way?
Whatever the flaws of Obamacare, it did re-set the bar such that real healthcare reform, aspiring, at least, to eventual universal care at affordable prices, is now firmly in the public mind, and even the Republicans must respond. It is no small irony—actually hypocrisy—that in the early 90s, Republican current senators Chuck Grassley and Orrin Hatch along with then senators Bob Dole and Richard Lugar and House Majority Leader Newt Gingrich latched on to the conservative Heritage Foundation and American Enterprise Institute’s idea of an individual mandate for healthcare. Thus armed with the imprimatur of conservative think tank bona fides, they boldly proposed it as an alternative to anything First Lady Hillary Clinton might come up with. The theory was that if everyone had it, not just the sick and elderly, prices would be affordable, we’d have universal healthcare, and those who already had it would no longer be subsidizing the many who did not and who sought out hospital emergency rooms since hospitals could not turn them away. In the curious flip-flop of party politics, the Democrats—rarely averse to a touch of hypocrisy themselves and hoping for better—were extremely lukewarm about the mandate idea, being leery of its provenance, and so of course it was never passed. It was a reasonable idea then, and it was just as reasonable when Obama proposed it as a key element in his healthcare reform package. It was also reasonable when Massachusetts Republican Governor Mitt Romney signed the mandate into law in his state. But somehow, in that magical way that political hypocrisy is portrayed as high principle, when Obama promoted the idea, it suddenly became the work of the devil and represented a godless attack on capitalism and a government overreach heralding the birth of American totalitarianism. The Grassley-Hatch-Gingrich-Bob Dole embrace of the mandate in the early 90s was happily long forgotten, and Democrats were weak in reminding the populace of it, likely because their view of it back then when it was a conservative idea was moderately contrary to their own present enthusiasm. Romney, as presidential candidate in 2012, was not quite so fortunate in escaping the national amnesia, being frequently peppered with questions about Massachusetts’ more recent Romneycare. But, as an accomplished politician, he wriggled and squirmed and demurred at all comparisons of his mandate and Obama’s mandate.
Meanwhile Foxy News—sorry, Mr. Ailes and Mr. O’Reilly; well, not really—aka Foxy Nudes, aka Faux News, aka Fake News, rails against all things Obama and what was originally a Republican idea is now transmogrified into the work of Beelzebub himself. This stokes the Gullibles, and the GOP, fearing another entitlement, excoriates Obama and his diabolical and un-American plan. They suffer a serious blow when temporarily apostate Supreme Court Chief Justice John Roberts actually affirms the constitutional legitimacy of the mandate, giving Obama a rare 5-4 Court victory, and earning the Chief Justice the eternal loathing of those masses who are largely ignorant of The Affordable Care Act’s actual provisions but know very well which president concocted it, which is all they need. So Obamacare escapes an early grave. Nevertheless many uninsured do not enroll, especially many younger, healthier Americans, despite subsidies for lower income enrollees, and they are reluctantly willing to pay the modest penalty for failing to do so. Consequently, the “universal” part does not kick in well. Predictably insurance companies raise prices, partly because it’s just what they do, and partly because they are no longer allowed to refuse coverage for pre-existing conditions, nor are they allowed to kick someone off coverage for exceeding maximums allowed for expensive medical conditions.
Citizen Trump, and later candidate Trump, has managed to take about every side possible concerning healthcare, which obviously means he has no real convictions at all. He has stated, in a debate, “I like the mandate.” He has blamed legislators and insurance companies for being in thrall to each other. He has actually endorsed the importation of lower-priced Canadian drugs, competition among insurance companies across state lines, and even, back in the day, a national, single-payer system—all anathema to conservatives whose fierce opposition to all of those has forced him into line. Candidate Trump, whose own physician appears to have just been released from the local de-tox rehab center and who declared in a momentary fit of ecstasy that Trump is the healthiest candidate ever to run for the presidency, promises to repeal and replace Obamacare on his first day in office with “something terrific.” Naturally he doesn’t have the remotest idea what that would be, nor do his fellow Republicans, as evidenced by their recent failure to do what they have long promised despite their congressional majorities and Trump in the Big House. Now that the luster of “repeal and replace” has been tarnished a little, the current GOP shibboleths are “patient-centered healthcare” and universal “access” to healthcare. The first one trips off Republican tongues as if it actually means something, which of course it does not, but it makes a deliciously invidious comparison to Obamacare, which by implication must not be interested in patients at all. The second one, like all political rhetoric, also sounds appealing—“access.” Heck, who doesn’t want access? By what conceivable right does the many-tentacled government deny me “access” to something I want? The worm in that pretty apple, as Bernie Sanders pointed out to Ted Cruz in a post-election debate on healthcare, is that everyone already has access to healthcare, just as Bernie has access to buying a Maserati. But if you can’t afford it, then “access” is a sweet-sounding but meaningless term. Or, rather, what it does mean is that those who can afford it can have it, and those who can’t—well hey, it’s a Darwinian world out there.
And that is where the political divide really is: Is healthcare a right, whose costs are to be amortized among all Americans, with the wealthy subsidizing the unwealthy; or is it a normal commodity like cars or L. L. Bean coats, where those who cannot afford it, even those working full-time, will just have to do without? (Or, as Representative Chaffee has characterized it in Marie Antoinette fashion, they should quit buying a new cell phone every few months so they can afford it.) Obama has forced the Republicans to come forward a little; even they now must speak favorably of preserving the ban on excluding those with pre-existing conditions as well as allowing individuals to stay on their parents’ healthcare until age 26—both progressive features of Obamacare. The problem is that they want the dessert but don’t want the vegetables, the vegetables being the mandate and the higher taxes on the wealthy which are indispensable pieces to make the whole thing work. In that sense it is simple economics: the goodies have a cost, and if you take away the mechanisms for paying for the cost, the system falls apart.
Having promised for years, the Republicans are trapped in their “repeal and replace” rhetoric, and Democrats are firmly resolved that no repeal will take place with their help. Senate Minority Leader Charles Schumer has, however, offered that if repeal is abandoned by Republicans in favor of fixing some of Obamacare’s problems, Democrats would be open to that. Two obvious reforms would be allowing insurance company competition across state lines, and allowing Medicare and Medicaid to negotiate with drug companies for lower prices. Aren’t Republicans all for capitalist competition? Well, they are at least until corporate lobbyists with lots of dollars to dispense convince them otherwise. And what possible objection would Democrats have? Other bones will be much more difficult to pick, especially the “right” of healthcare vs. “access” to it, and the who pays, who benefits implications of that. Nobody, of course, is talking about a single-payer plan, as Canada and Britain have. Research indicates that those countries have lower per capita costs and equal if not better health outcomes. But that is not on the table—Democrats are too cowed to mention it and are aware of the corporate interests that would never allow it, while Republicans support those corporate interests and have screamed “government takeover” so long that some actually believe it.
So we’re still waiting for “something terrific.”