I told you so! The principle that the federal government will guarantee health care coverage has been established, and Republicans will not end that

From July 20th:

More at the original. As I said (on the 19th), none of the Republican plans have been anything more than Obaminablecare Lite, because there are only so many ways you can utilize the private, for-profit insurance system to force coverage for everybody.

The plain fact is that about half of Republicans — including me — objects to Obysmalcare not due to the way in which it attempts to provide insurance coverage for everyone, but that the government is trying to provide health care coverage for those who cannot or will not pay for it themselves in the first place. The problem is that the other half of Republicans might hate Obumblecare but agree with the cockamamie notion that the government should be responsible for providing health care coverage, and the GOP’s electoral advantage depends in part on a significant number of people who would lose health insurance or Medicaid if the current law is repealed.

There are only two significant ways to change the laughably-named Affordable Care Act: either total repeal, with no replacement, or single-payer. Every Republican congressman and Senator knows that voting for repeal only will take away health care coverage from some of the voters who put them in office.

So, after all sorts of near-midnight twists and turns, and with threats that Republican Senators who voted against repeal of the Affordable Care Act would be targeted in their next primary elections, the Republicans needed the political cover of three sacrificial lambs they got them:

  • Senator Susan Collins (R-ME), age 64, term ends January 2021;
  • Senator Lisa Murkowski (R-AK), age 60, term ends January 2023; and
  • Senator John McCain (R-AZ), age 80, term ends January 2023.

Senator Collins, as Patterico noted, did not lie to her constituents: in 2015, she voted against the Republican bill to repeal the Affordable Care Act. She doesn’t face the voters until 2020, and, in Maine, voting to preserve the ACA isn’t a liability. She will be 68 when she would next face the voters, and might choose to retire.

Senator Murkowski did vote for the 2015 repeal only measure, knowing it was a safe vote, because President Obama would veto it. Mrs Murkowski is in no way afraid of the voters in Alaska: in 2010, when she lost the Republican primary to TEA party candidate Joe Miller, she simply ran as a write-in candidate in the general election, and won. She will not face the voters again until 2022, at age 66.

Senator McCain did vote for the 2015 repeal only measure, knowing it was a safe vote, because President Obama would veto it. Already 80 years old, Mr McCain would not face the voters again until he is 86 years old, if he chooses to run again. Having recently been diagnosed with glioblastoma, an aggressive form of brain cancer. Standard treatment options for this tumor include chemotherapy and radiation, although even with treatment, average survival time is approximately 14 months.

In my article of the 20th, I (reluctantly) supported a single-payer health care plan, because I admitted, to myself, that the federal guarantee of health care coverage would not be repealed. When I cross-posted that article on RedState, it received 112 comments, most of which were in opposition. But, opposition or not, I was right, because there are only a limited number of options:

  1. Some form of single-payer plan, such as extending Medicare to cover all Americans;
  2. Some form of guaranteed private insurance, which is how the Affordable Care Act works; or
  3. Ending the federal guarantee of health care coverage.

The Republicans have already accepted that the guarantee is an established principle, so the third option has been taken off the table! That leaves us with either single-payer, or something at least similar to the ACA, and the Republicans proved unable to craft anything different enough from the ACA to both gain the necessary support and be different enough from the ACA to keep their promise to repeal it.

Well, the ACA has proved to be horribly flawed, as conservatives said it would be when it was passed. The record of the ACA is huge premium increases coupled with insurance companies losing money on ACA exchange programs, resulting in roughly a fifth of Americans who must use the exchanges to secure health insurance having only one company from which to choose. Even with that, a couple of places were looking at having no company selling ACA insurance on the exchanges, until politicians cajoled one or another to fill the void.

The ACA is failing, and will collapse completely. I have said it before: the left only sought to get something, anything, passed, to secure the federal guarantee principle. Then, when the ACA finally fails, they’ll throw up their hands and say, “See, we tried it the conservative way, using the private health insurance system, and now single-payer is the only thing left to do.” Well, with the principle established, they were right!

The time has come for Republicans to take the lead, and structure single-payer as efficiently as possible. It has to dramatically reduce malpractice claims, by restricting any damages to actual damages, and end punitive damage claims, and it has to limit coverage to American citizens, and those immigrants who both pay Medicare taxes1 and are in the country legally.

I do not like single-payer not in the slightest; to me, it’s only advantage is that it will be less bad than the ACA or something similar. I expect health care under single-payer to get worse, to something similar to what Sachi ab Hugh described concerning Japan’s single-payer system, or with the built-in delays used by Canada and the United Kingdom, and our own Veterans Administration, to control costs. But when even the Republicans will not end the federal guarantee, we have no other realistic option.
Cross-posted on RedState.

  1. This assumes that any single-payer system will be an expansion of the Medicare system. Full disclosure: I will be eligible for Medicare next April.


  1. It’s simple: Republicans ran on promise to “repeal and replace” the ACA, and they could never agree on anything to replace Obysmalcare with anything that didn’t look a lot like Obaminablecare.

  2. This process started a long time ago, when Republicans stopped running on repealing Obaminablecare to ‘Repeal and Replace’ it. With that promise, they conceded the point I have been saying all along that has been conceded, that the federal government is ultimately responsible for people having health care coverage. Once that concession is made, the option of just repealing Obysmalcare, of returning to 2008, is off the table.

    Of course, they figured that they’d have [shudder!] President Hillary Clinton there to veto any repeal, and they never figured that, oh Hell! they’d be responsible for coming up with a replacement that would satisfy the American people. :(

    All that leaves is either some form of single-payer, or a private insurance plan similar to Obumblecare. The GOP couldn’t come up with a plan that wasn’t different enough from Obastardcare to gather much GOP support and still keep their promise.

    The problem is simple: about half of Republican voters want Owfulcare just plain gone, because they recognize that it’s nothing but another f(ornicating) welfare program, while another half agree with the concept that health care is some sort of government-guaranteed right; ‘moderate’ Republican politicians exist because there are moderate Republican voters.

    With the option of straight repeal off the table, the only options left are something very similar to the ACA, or single-payer. And the only truly different plan the Republicans could adopt would be single-payer. I told you that this would happen! We will have single-payer either sooner, if the GOP goes for it, or later, when Obuggerycare collapses, and the Democrats are writing the plan.

    The GOP needs to get out in front of single-payer, and include provisions that it not include coverage for elective procedures — abortions, sex change operations, liposuction or non-reconstructive plastic surgery — and that only American citizens and legal residents paying Medicare taxes are covered. Those provisions need to be in the law itself, to keep President Kamala Harris from issuing ‘regulations’ which change those provisions.

    In the end, if you believe that the Republicans will ever reverse the principle that the government is ultimately responsible for to it that everyone has health care coverage, you are lying to yourself! Denying the truth at the beginning is no way to ever come up with a good plan.

  3. The time has come for Republicans to take the lead, and structure single-payer as efficiently as possible.

    Sorry, but this is Surrender Monkey-ism. It’s a good thing the NRA never felt this way “Ooh, let’s just surrender on gun control, it’s going to happen anyway”. Giving up is not leadership, it’s just, well, giving up.

  4. The time has come to make sure absolutely no attempt is made to save Obamacare. The time has come to make every effort to intensify and rush the collapse of Obamacare and to undeniably pin it on the Democrats. The time has come to force the people to demand the Republicans REPEAL Obamacare for the good of America. Now, some people will die but be happy in the knowledge that the vast majority of them will be voting democrats who wanted Obamacare. Now they got it.

    The time has come for Republicans to take the lead, and structure single-payer as efficiently as possible.

    BTW, the most efficient single payer plan would necessarily include abortion on demand, infanticide for those born with birth defects, government “approved” diseases, injuries, and procedures as well as government “disapproved” of the same, euthanasia for those with unrecoverable ailments and injuries and mandated government assisted suicide for people over a certain age as they no longer pay for themselves. I think several societies have tried this. Can you think of some?

  5. While I agree with the premise of your single payer argument, it’s beyond the realm of reasonable thinking that the rabid right or so-called conservative lawmakers of today could ever entertain such a notion. And even if they did (which is a laughable “if”), it would certainly be so watered down that it would be useless.

    It’s also remarkably mind boggling to think that today’s so-called conservative lawmakers have an iota of concern for the uninsured. The goal leans more toward pulling funding away from Medicaid and such programs and steer that revenue to their corporate donors. And that’s pretty much what the TrumpUniversityCare is all about.

    Rs have pretty much painted themselves in a corner over the last 7 years. Grandmas weren’t rounded up by some Gestapo police force to be brought in front of some death panels to plead for their lives, Down Syndrome babies weren’t euthanized, no long lines at the doctor, doctors didn’t flee their professions, jobs didn’t dry up, and it saved many lives. After years of lying and fearmongering, people have come to like OC or at least come to really like some provisions such as the exclusion of pre-existing conditions.

    So while the Rs have pretty much bet the farm on repealing OC, it simply cannot be done without bringing back pre-existing conditions, kicking a minimum of 15 million out of insurance, and spiking premiums a minimum of 20%. You cannot take the main components such as the individual mandate and device tax (both bitterly despised by Rs) and still preserve pre-existing, coverage to 26 yrs old, and the other aspects the electorate has come to appreciate.

    And yes, OC has its share of flaws. What today’s so-called conservatives really need to do is to get off of their plutocratic high horse, put aside their festered hatred of the previous POTUS, swallow their pride, and reach across the aisle and go to work to fix the problems.

  6. The President of the United States tweeted:

    Could that be because President Trump, who promised a “great” health care plan on the campaign trail, didn’t present one to the Congress?

    6 promises Trump has made about health care

    By Henry C Jackson | 03/13/2017 10:14 PM EDT

    No one will lose coverage. There will be insurance for everybody. Healthcare will be a “lot less expensive” for everyone — the government, consumers, providers.

    President Donald Trump and his advisers have been talking about an Obamacare repeal and replacement plan, and making blanket statements about what it would entail, for nearly two years. In his recent speech to Congress, Trump cast his presidency as one of promises made and promises kept. And he and his aides have made plenty of promises about healthcare.

    Now there is a plan on the table: the American Health Care Act. The House-produced bill, endorsed by the White House, will repeal and replace the Affordable Care Act. But an analysis of the measure, from the nonpartisan Congressional Budget Office, found that the bill would cause about 24 million people to lose coverage over the next decade — a finding that will test Trump’s health care claims. Notably, the White House has made it clear they reject the analysis.

    Here’s a look at six promises Trump and his advisers have made about replacing Obamacare, and how it compares to the CBO score:

    Before he was sworn in, President Trump made a bold promise: The as-yet-unreleased Obamacare repeal and replacement plan would have “insurance for everybody.”

    “We’re going to have insurance for everybody,” Trump said in an interview with The Washington Post. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

    While House Republicans and the White House have indicated repealing and replacing Obamacare may take multiple legislative steps, the bill currently on the table would not meet Trump’s pledge. Per the CBO’s score, 14 million people would immediately lose coverage, a number that would eventually rise to 24 million over the next 10 years.

    Of note: The White House disputes these CBO projections. “It’s virtually impossible to have that number occur. Not believable,” Health and Human Services Secretary Tom Price said on Monday.


    As his run for president took shape, candidate Trump boasted via Twitter, “I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid” — before arguing that GOP also-ran Mike Huckabee was copying him.

    That’s another promise that wasn’t born out by the CBO, which found the House Obamacare repeal measure would cut Medicaid by $880 billion.


    Trump counselor Kellyanne Conway made a promise that almost certainly can’t be met with the House bill: “We don’t want anyone who currently has insurance to not have insurance.”

    In its current form, the CBO says Conway’s promise simply won’t be kept in the House bill. An estimated 24 million people will lose coverage over the next 10 years under the plan.


    Health and Human Services Secretary Tom Price praised the House’s repeal and replace plan on Sunday’s NBC’s “Meet the Press” arguing, “I firmly believe that nobody will be worse off financially in the process that we’re going through.”

    The CBO’s analysis doesn’t evaluate each individual’s financial situation. But its score projects health premiums under GOP health bill would increase by an estimated 15 to 20 percent over the bill’s first two years — before falling thanks to looser regulations and more younger enrollees. Older enrollees, though, could face higher premiums or costs.


    Throughout the 2016 campaign, candidate Trump talked about his desire to let people buy health insurance across state lines. The idea being that it will create competition and offer better choices for people when they purchase health insurance.

    “We have to get rid of the artificial lines around the states,” Trump said during the second presidential debate.

    This promise isn’t met — or even addressed — in the House’s bill, a point of complaint for some conservatives. House Speaker Paul Ryan has attributed this to the need to avoid a filibuster while using the fast-track legislative process known as reconciliation. Trump, though, pledged on Twitter he would get to it eventually in a second or third phase of his repeal-and-replace effort.


    Trump has made other, more vague promises about the repeal-and-replace endgame.

    As he campaigned for the White House that he declared in an interview with CBS’ “60 Minutes”: “I am going to take care of everybody … Everybody’s going to be taken care of much better than they’re taken care of now.” More recently, Trump has promised that repeal will end with “a beautiful picture.”

    Both of these pledges are harder to quantify — but judging by early reactions to the legislation from liberals, some conservatives and others, it will be difficult to ensure.

    Candidate Trump made a lot of promises concerning health care; President Trump not only hasn’t delivered, other than fussing about the Senate vote, he hasn’t even tried.

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