By Eugene Robinson
Sooner or later, we will have universal, single-payer health care in this country — sooner if Republicans succeed in destroying the Affordable Care Act, later if they fail.
The repeal-and-replace bill passed by the House last week is nothing short of an abomination. It is so bad that Republicans can only defend it by blowing smoke and telling lies. “You cannot be denied coverage if you have a pre-existing condition,” House Speaker Paul Ryan said — true in the narrowest, most technical sense but totally false in the real world, since insurance companies could charge those people astronomically high premiums, pricing them out of the market. “There are no cuts to the Medicaid program,” Health and Human Services Secretary Tom Price said — a bald-faced lie, given that Republicans want to cut $880 billion from Medicaid in order to offset a big tax cut for the rich.
The nonpartisan Congressional Budget Office predicted that an earlier version of the American Health Care Act, as Trumpcare is officially called, would result in 24 million Americans losing health insurance over the next decade, with 14 million of those unfortunates losing coverage within the first year. Republicans rushed to vote Thursday on the final bill before the CBO had a chance to score it, doubtless fearing the projected decimation could be worse.
I can’t think of a more effective way to drive the nation toward a single-payer system. In their foolish haste to get rid of Obamacare, Republican ideologues are paving the way for something they will like much less.
The country will ultimately be much better off, though. Every other rich industrialized nation has found that truly universal health coverage is like what Churchill said about democracy: It’s the worst system except for all the others that have been tried.
When President Obama decided to tackle health care, he chose a framework that had been developed at the right-leaning Heritage Foundation. The ACA is based on what began as Republican ideas: Maintain the basic system of employer-based health insurance provided by private-sector companies; set up exchanges to service the individual market; provide subsidies to help the working poor afford insurance; expand the reach of Medicaid; guarantee reasonably priced coverage to those with pre-existing conditions; and impose an individual mandate to ensure that younger, healthier people either buy insurance or pay a fine.
It’s a complicated scheme but it can work, as Republican Mitt Romney proved when he enacted a similar plan as governor of Massachusetts. And since the ACA maintained the basic private-sector structure of our health care system, Obama reasoned that surely it would win some GOP support in Congress.
He was wrong. Only Democrats voted for the ACA, and Republicans turned its repeal into a partisan crusade — leading, eventually, to Thursday’s vote.
I have always believed, however, that Obama was prescient in seeing that the ACA would have a larger impact that would be difficult if not impossible to erase, no matter what Republicans did to the law itself: It established the principle that health care, as Obama said in accepting the “Profile in Courage” award at the John F. Kennedy Library on Sunday, is “not a privilege but a right for all Americans.”
Ryan and the House Republicans obviously disagree, but polling suggests they are increasingly out of step with the nation. In Gallup’s most recent survey, the ACA had an approval rating of 55 percent, its highest to date. Perhaps more significantly, 52 percent of those polled agreed with the statement that “it is the responsibility of the federal government to make sure all Americans have health care coverage,” versus 45 percent who disagreed — a sharp turnaround in the last couple of years.
Those majorities may seem less than overwhelming, but the trend lines are clear. If tens of millions of Americans lose their insurance coverage and the most popular provisions of Obamacare are nullified, how do you think opinion will evolve?
If nervous Senate Republicans refuse to walk the plank, Obamacare will remain in place. But President Trump and the GOP majorities in Congress now own the health care issue, and if they don’t stop trying to sabotage the ACA and instead try to make it work, voters will be angry. And if the Senate does go along with the House, I believe many Democrats will run in the 2018 midterms — and win — on Sen. Bernie Sanders’ pledge of “Medicare for all.”
With their anti-Obamacare fanaticism, Republicans are putting single-payer on the table. Thanks, GOP.
Eugene Robinson’s email address is eugenerobinson@washpost.com.
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