Winston Churchill said democracy is the worst form of government, except for all the others. It may turn out that Obamacare will be seen in a similar light.
Democrats readily acknowledge that the Affordable Care Act needs revision. This is a massive program and we knew going in that it would take years to work out the kinks. It is certainly not in a “death spiral” as some say. The uninsured rate is low and millions of folks have health care insurance for the first time in their lives. (For a quick reminder of what Obamacare really is and why it was needed, check out this column.)
But Republicans are twisting themselves into pretzels trying to come up with something better. Right now CNN is reporting that 21 GOP members of Congress are leaning towards a NO vote on Trumpcare. That puts it on the cusp of failing to pass. Politically, they’re stuck; if they make the plan more lenient the conservative wing will bolt, and if they make it even more stringent (the CBO says 14 million people will lose insurance in the first year!) more “moderates” will defect.
Here’s the GOP’s problem in a nutshell. Insurance is pure numbers. The insurance companies need to balance X expected income against Y expected outflows. When Obama said those firms could no longer discriminate against those with a pre-existing condition, and that they could no longer set life-time caps, it was based on having large numbers of younger, healthier folks sign up for health insurance. Hence the mandate; it forced those younger people to buy the insurance.
But now President “Nobody knew health care was so complicated!” (um, everyone knew) has promised to keep all of Obamacare’s good parts. Heck, he went further and promised to deliver health care for all Americans. Great. Now go figure out how to do it. Without Medicare for everyone, or some sort of mandate to increase the pool of insured people, you can’t make the numbers work. Period. Thus the Republicans have boxed themselves into a corner.
The great irony is that if any form of Trumpcare passes a vast swath of Trump voters will be the ones hurt most by the new plan. Then again, they are the ones polls show are most likely to not know that Obamacare is the Affordable Care Act. Which would be funny … were it not a matter of life and death.