GOP is dead, Obamacare is alive

Remember back in 2012 when then-vice president Joe Biden told us, "Bin Laden is dead; General Motors is alive"?  The good old days.  That was also around the time Senators John McCain and Lisa Murkowski promised to repeal Obamacare – along with a bunch of other Republicans seeking re-election to Congress.

Fast forward to 2017.  The new catchphrase is "GOP is dead; Obamacare is alive."  At least their credibility is dead, buried in the rubble of broken campaign promises: not only Obamacare repeal, but also tax cuts, immigration enforcement, balanced budgets, reduced spending, and so on.

Repeal and replace, as a promise, was simple enough on the campaign trail.  We heard this promise in 2010, when voters gave the House to Republicans.  We heard it again in 2012, when voters gave them the Senate.  Despite their controlling Congress, Obamacare remained alive and well.  Candidate Donald Trump, along with most Republican members of Congress, promised repeal and replace last year.

Eight months into the Trump administration, Obamacare is still kicking.  Congress had three bites of the apple this year and each time came up with a worm.  This week was their third attempt to fix Obamacare.  It was not the promised repeal, but instead only financial window dressing to keep Obamacare alive in some shape or form.

Graham-Cassidy didn't even earn a Senate vote this week after three promised GOP defections.  Too bad they didn't vote.  Senator Richard Shelby thought a vote was fruitless, saying, "Why have a vote if you know what the outcome is and it's not what you want?"  Why?  How about getting the senators on record with a yea or nay vote?  Votes that they could be reminded of during their next campaigns?

Once again, the do-nothing Congress has squandered a once-in-a-generation, or lifetime, opportunity to advance a conservative agenda.  Instead, after eight months, they have little to show for their control of the executive and legislative branches of government.  Obamacare remains the law of the land.

Republican lassitude is not lost on voters, as Luther Strange learned this week.  Senator Bob Corker noticed, too, choosing to do nothing as a private citizen rather than as a U.S. senator.  Congress may not want to repeal Obamacare, but the voters do.

Many want a simple repeal, similar to what Congress passed multiple times, certain that their virtue-signaling repeal bills would be slapped down by an Obama veto.  Now that the veto threat is gone, so are the votes for repeal.  It won't happen.  Neither will the IRS ever be abolished or the Departments of Education and Energy be closed.  All conservative pipe dreams far from the reality of current Washington, D.C.

Obamacare remains in a death spiral – another year of double-digit premium increases, some families paying more for their Obamacare insurance premiums than for their mortgages, not to mention rising co-pays and deductibles and narrowing physician and hospital networks.  All of this makes medical care unaffordable for many Americans, even though they have insurance.

What's next?  Waiting in the wings is Bernie Sanders's "Medicare for All" bill, which has the support of 17 Democratic senators, more than a third of their caucus.  On the House side, John Conyers has his own version of single-payer with 119 cosponsors, more than half of the Democrats' House caucus.

America is already drifting toward single-payer.  Medicaid, Medicare, and the VA System are all single-payer health insurance plans – or, more accurately, government-run health care systems.  Obamacare is following this path.  A third of counties have only one Obamacare insurer.  It's not far from what we have now to a true single-payer plan.  And the Democrats are ready and waiting to take advantage of Republican chaos and an imploding Obamacare.

Perhaps this was the plan all along.  It was then-senator Obama who once said single-payer is the goal, but "we can't get there immediately."

If President Trump cannot get anything done with his own party in Congress, maybe he calls his new buddies Chuck and Nancy – John McCain's extolled "reaching across the aisle."

Suppose Donald, Chuck, and Nancy cook up a two-tiered system, something for everyone?  A public option and a parallel private option.  Just as most developed countries have.  The public option covers everyone.  Think of Medicaid for all.  A bare-bones catastrophic coverage plan available to all Americans.  With minimal or no out-of-pocket costs to patients but with the tradeoff of long wait times for care and limited treatment options.

The private option allows individuals to purchase medical insurance or actual care directly, what they want and need, nothing more.  Insurance without mandates and regulations.  No subsidies, tax breaks, or government assistance.  Pure free market.

Think of K-12 schools.  Public schools are available without cost to all students – for most, a good education.  And there is a private school option for those who desire and have the means.  Pay the private cost, or default to the public option and pay nothing.

There are pros and cons to each system, but both are separate and distinct, each doing what it's designed to do – rather than an amalgam of both systems, which is what we have with Obamacare, Graham-Cassidy, skinny repeal, or whatever the witches and warlocks of Congress conjure up.

This is something for both the right and for the left.  Free market for the right.  Universal coverage for the left.  Perhaps it's the only way to get past the current logjam in Congress.  If Republicans continue to twiddle their thumbs and do nothing, they may soon find themselves in the minority, leaving Bernie in charge.

If the Democrats control Congress, make no mistake: they will pass single-payer.  No defections.  They will change procedural rules such as the filibuster if necessary.  And they will accomplish what the Republicans are unable to.

In the meantime, Obamacare is alive, and it's the GOP on life support.

Brian C Joondeph, M.D., MPS is a Denver-based physician and writer.  Follow him on Facebook,  LinkedIn, and Twitter.

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