Obamacare forever

Repeal and replace Obamacare has gone down in flames.  Time to throw out the Republicans?  Better think twice on that one.

Republican failure to make good on the promise to repeal and replace the ACA might be the fault of a few senators.  But it is not the fault of principled Republicanism.  The failure to reverse Obama's state-centric signature legislation is due to the law's added entitlement and the importance of patronage in our representative form of government.  In short, too many voters in too many districts want government entitlement and will punish any politician who fails to deliver.  That is the "greater good."

The signature accomplishment of Obamacare is the swelling of Medicaid rolls.  By Democratic telling, the law created some 20 million new insureds, the bulk of whom are subsidized via Medicare.  This number is misleading because, however many ACA exchange policyholders there are, a substantial portion of them were forced to swap free-market policies for Obamacare policies.  This is where Obama's great lie met reality.

Regardless, the fact of new, subsidized policyholders is all we need to know to predict the fate of repeal-and-replace efforts.  Very few Republican senators will be secure enough to cancel these new entitlements, much less would RINOs like Susan Collins and Lisa Murkowski or the Democrats be willing to do so.  If entitlements are not canceled, the problem is merely extended in another name.  This is the source of the divided Republican Senate.  Any bill you can think of will either be effective but high-risk or ineffective.  For its part, the House bill has been criticized for ineffectiveness, a so-called Obamacare Lite.

There are other problems with reversing Obamacare, including the "mandate" and pre-existing conditions.  The mandate, which was carefully disguised by ACA author Jonathan Gruber (recall his "stupidity of the American voter"), is an actuarial necessity in any state-run insurance system.  The fact that Supreme Court chief justice Roberts rewrote the law to change "penalty" to "tax" is an incidental detail.  Everybody knows what Gruber, Baucus, Pelosi, and Reid meant when they argued that the mandate wasn't a tax.

And coverage of pre-existing conditions – which is lauded by left and right alike – is not insurance.  This is not to say we should deny help to our less fortunate fellow citizens suffering recurrence of some pre-existing medical condition.  But insurance is about events that may happen, not certainties.  If we want to help the unfortunate, there are more direct ways than insurance.  No one speaks of them, but they exist.

I challenge anyone to come up with a repeal-and-replace plan that a) reduces the cost of premiums and care, b) makes insurance and care available to most if not all citizens, and c) maintains re-election viability at the same time.  I do not think it can be done.  We may yet see a new law, but it will not accomplish the trifecta.

Of course, there are other ways to skin the cat.  But again, no one is talking about them.  While Obamacare represents a major expansion of the federal government, it is not the first government foray into the medical field.  Medicare already dominates the health care industry, even for coverage and care outside this government program – so much so that no one knows the real cost of any medical services.  The watchword – and the problem – is, is it covered?

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