Another Dreary Round of Health Care

President Donald Trump and the rest of the Republican party are once again gearing up for another big fight over health care, and the Democrats are clearly relishing it. What the Republicans are proposing might well be good policy, as nobody seems to know what it is, but for now it looks like very bad politics.

From the day in 2010 that President Barack Obama and his temporary supermajorities in the House and Senate enacted the Affordable Care Act — better known as Obamacare to both fans and critics — the Republicans have been intent on repealing and replacing it, and with the same intensity that Captain Ahab tried to kill Moby Dick. Despite some legal arguments we found quite compelling the Republicans lost a court challenge when the Supreme Court ruled in 2012 that the law’s mandate every American must purchase health insurance was constitutional, and after that the Republican majorities would vote every few months to repeal all of it, but they never had the votes needed to override the inevitable presidential veto. When Trump took office the Republicans took another crack at it, but that fell a vote short in the Senate, and for a while that seemed to settle the matter.

Now Trump has the Justice Department again challenging in the law in the courts, however, and he’s also urging his party’s congressional to repeal it. Despite the two Supreme Court justices Trump has appointed the court challenge seems a long shot, especially after Trump has successfully ended the hated “individual mandate” that was at the heart of the previous decision, as Supreme Courts are traditionally loathe to overturn precedents, and the legislative action Trump is urging will be an even harder sell.

Obamacare is a governmental intrusion into a fine free market health care system that goes against every instinct in our traditional conservative Republican bones, but by now there’s no denying that much of it is very popular. The law allows people with pre-existing medical problems to purchase health insurance, which Republicans reasonably argued is akin to letting people purchase fire insurance after their house burned down, but the insurance industry has somehow survived, and no Republican including Trump wants to go on record denying coverage to someone who’s been diagnosed with diabetes. Insurance stocks remained stable largely because the law forced every American to buy an insurance plan, but they’re still up even after Trump ended that unpopular nonsense, which does undermine our free market arguments. Obamacare also subsidizes health insurance for an estimated 20 million Americans, too, and although that goes against every instinct in our traditional conservative Republican bones no one in the Grand Old Party wants to see the headlines about 20 million Americans being left without access to health care.

For the past nine years both the pre-Trump and Trump-era Republicans have sought to repeal and replace Obamacare, and they’ve done well with the repeal part but have struggled to come up with a popular replacement. Trump ran on vague promises of a wonderful health health care system that would cover every American no matter their pre-existing conditions at greatly reduced prices, but he’s yet to explain exactly what that looks like, and we doubt he ever will. None of the Republican proposals would insist on coverage for people with pre-existing conditions, all of them wold result in millions of Americans losing their health insurance, and at this point there’s no one left in the Republican party who’s rock-ribbed enough to make the argument that as harsh as it sounds it ends up to the greater good.

Which is a damned shame, as those damned Democrats seem currently hell-bent on some even more cockamamie schemes to repeal and replace Obamacare, which they never really liked because it wasn’t nearly intrusive enough. Many of the congressional Democrats and several of the contenders for the party’s nomination are advocating what they call “Medicare For All,” which is a catchy way of saying full-blown socialistic single-payer program, and we don’t see that ending well. The once-controversial and now widely-accepted Medicare program is doing a pretty good job of taking care our aging parents, who had paid plenty into its funds over the years, but it’s trustees are warning that it’s going belly-up in the few fleeting years until we’ll eligible and compelled to join, and despite their youthful idealism we don’t think any of these young whippersnapper Democrats can make it work for everyone.

Health care is a complicated issue, and neither of our major parties seem to have any good ideas about it, and we have to admit that neither do we. At least we’re not making grandiose promises, except for our glum assurance that we’ll all eventually die.

— Bud Norman