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Flatiron Hot! News | January 14, 2018

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Flatiron Hot! Pundit: The Affordable Care Act May be Doomed, But Universal Health Care is Within Reach

Flatiron Hot! Pundit: The Affordable Care Act May be Doomed, But Universal Health Care is Within Reach
Eric Shapiro

By Eric Shapiro for the Flatiron Hot! News

In a development as inevitable as an early-morning Trump tweetstorm, the GOP just voted to begin debate on repealing Obamacare. But for the Democratic Party, the debate is already over. The Affordable Care Act may not technically be dead yet. But it’s in critical condition. And if the GOP does not drive a stake into the heart of President Obama’s signature achievement, they will surely dismember it beyond recognition, at the cost of many a life and livelihood. Although it appears that the death blow won’t come via a comprehensive replacement bill, Republicans in Congress can and will chip away at the ACA through amendments, aided by a Trump Administration’s that refuses to provide necessary subsidies to stabilize insurance exchanges. Although the basic framework of Obamacare may well survive in some form, its overall prognosis is grim even.

All metaphors aside, the fate of the ACA may be shocking, but it should come as no surprise. The Affordable Care Act as it currently exists was doomed the moment Donald Trump became president. It had a perfect storm of reactionary sentiment aligned against it. The Republican Party is dogmatically opposed to even the slightest expansion of the welfare state, while Donald Trump is obsessed with undoing his predecessor’s legacy and, above all, scoring wins. And what better way to score a “win” than by keeping a promise that few Americans want see kept? To be sure, repealing the Affordable Care Act is not an accomplishment by any measure. The GOP, in control of both houses of Congress and the presidency, struggled mightily just to get to this point. If not for the massive dysfunction of a party more fit to throw fits than to govern, Obamacare would have been crippled much sooner.

Liberal pundits will, of course, insist that the Affordable Care Act is not yet dead. They will erupt in triumphalist glee with every hiccup that the GOP’s bound-to-be-terrible replacement experiences in its crib, just as they took every one of the House and Senate bills’ stumbles as a sign that Obamacare would endure. But as always, Democrats have underestimated the lengths to which a singularly vicious and reactionary GOP is willing to go to ensure tax cuts for the wealthy and varying degrees of pain for everybody else. The so-called “moderate” Republicans (with the possible exception of Susan Collins) never seriously objected to the concept of a bill that, according to the CBO, would deprive tens of millions of Americans of healthcare. Rather, they sought to use what little leverage they had to win token concessions, table scraps to throw to their constituents in the hopes that they could pass themselves off as something approaching humane. But conservative ideology does not allow room for humanity and critics of “repeal and replace” like Bernie Sanders are absolutely right to point out that scrapping the Affordable Care Act will directly lead to deaths. Should Obamacare die, a public health crisis will inevitably ensue.

Democrats may never have been able to sell “Obamacare” to the American people (although the prospect of its demise did, tellingly, increase its popularity), but they did manage to sell the idea that government ought to provide citizens with healthcare. The GOP may hope that the public will tacitly consent to going back to the way things were before with, if the “moderates” get their way, a few little adjustments. But they’re wrong. The Affordable Care Act was a mess of a bill, the apotheosis of technocratic liberalism. It was an opaque, unintuitive jumble of market solutions cribbed from the Heritage Foundation spliced with government subsidies and a Medicaid expansion. And yet, despite being held together with the policy equivalent of bubble gum and scotch tape, the monstrosity was remarkably successful, expanding coverage to tens of millions (despite the Robert’s Court’s sabotage of the Medicaid expansion), mandating coverage for Americans with pre-existing conditions and slowing the growth of health care costs, to name a few of its many achievements. It also has considerable flaws; coverage is far from universal, the individual mandate is not enough to encourage many young, healthy people to buy insurance and the marketplaces, while functional, vary in quality from state to state along with premiums and deductibles. Many of these flaws have been exacerbated from the beginning by Republican sabotage, culminating in Donald Trump’s destabilizing efforts to artificially create a “death spiral” that the Affordable Care Act never generated on its own. And yet, such unpredictability is to some extent unavoidable when you place citizens’ health in the hands of market forces. The architects of the Affordable Care Act should have learned the same lesson as so many sick Americans: rely on insurance companies for anything and you’re bound to get fucked over. But alas, the political realities of 2009 arguably precluded a single-payer system or even a public option and those who sought health care reform worked with the tools they had.

The political reality of 2017 is much different. Enthusiasm for single-payer healthcare is building on the left, the Democratic Party and even among some Trump supporters. The American people support government-funded universal health care in concept, if not in name. Elizabeth Warren has come around. Even politicians at varying degrees of distance from the Democratic Party’s left wing including Cory Booker, Kirsten Gillibrand and Chuck Schumer seem open to the idea. Soon, Senator Bernie Sanders will unveil his Medicare-for-all proposal and we’ll see how many seemingly supportive donkeys are willing to rally behind it. Therein could be the silver lining of Obamacare repeal, as much as it is possible to find silver lining in a tragic decision that will literally cost lives. Democrats, whether out of genuine ideological conviction or political calculation, may finally treat universal healthcare as the moral issue that it is. And unlike the borderline-incomprehensible Affordable Care Act, healthcare for all is easy to understand and, should it become a reality, impossible not to defend. In the short term, we must fight to preserve what parts of the Affordable Care Act we can in order to minimize the human cost of its repeal and replacement. But simultaneously, we must lay the foundation for something better and more enduring.