After all the hydra heads of Trumpcare had been chopped off in one roll call after another, the Affordable Care Act and the health care system still lay in peril this week, subject to the whims of a vindictive president. But humiliating as it was for Republicans and scary for the 400,000 Arkansans and 20 million other Americans who had gotten health insurance, the ugly congressional battle did one wholesome thing.
It stripped away the political pretenses that all sides had conjured up for either defending or killing the 2010 health-insurance law that Republicans dubbed "Obamacare." It left standing the real issue from the health care debate's beginning in 2009 until today: whether people have a right to medical care. If they do, then the government is obliged to find a way to provide it for everyone.
That is what the Affordable Care Act, with all its interlocking and often confusing parts, was designed to do and what all the amendments and "replacement" bills set out to undo. They stripped away one or all the Affordable Care Act's mechanisms for helping people with incomes under 400 percent of the poverty line pay for coverage and to make it more affordable for those above the line. Every bill sank when the Congressional Budget Office and other analysts supplied the numbers: Millions would lose access to health care.
Although polls have long shown that most Americans think everyone should be insured, it is not a one-sided theoretical debate. Libertarians like Sen. Rand Paul (R-Ky.) and the so-called Freedom Caucus are frank about it: The government has no business subsidizing anyone's medical care. If a person can't afford it, she shouldn't get it. The whole safety net, from Social Security to Medicaid, creates a nanny state that whittles away at the liberties of people who are better off.
President John Quincy Adams said the great object of government was "the progressive improvement of the condition of the governed," but the contrary view is now in charge of all three branches — or at least it was before the actual voting on various Obamacare replacements, which would take insurance away from 15 million to 30 million people. Depending on the variation, from three to nine Republican senators voted against them and many others voted for them only on private assurances that the bills would not become law and expose them to the consequences.
Trump himself embraced the Adams theory. He always insisted that his plan (it was always near completion) or the bills he endorsed would cover every American with better benefits than Obamacare. CBO forecasts were fake news.
The repeal debates stripped away all the political shams that had made Obamacare so unpopular: that the government would decide if old people got medical care, that the government instead of doctors and patients would dictate care, that millions would lose health care rather than gain it, that Medicare would be bankrupted (Obamacare extended its solvency by 10 years), that it would bankrupt the country (it reduced budget deficits) and that it would close businesses and slash jobs (it did the opposite).
The defeat of all the bills left governors everywhere, including Governor Hutchinson, happy because it left intact the whole Medicaid program, a budget saver and economic boon for the states.
Trump, whose mere election after promising to kill Obamacare, rattled the insurance industry and began to drive carriers out of the market, threatened to destroy the whole scheme in retaliation for the defeat of the repealers. He can do it by stopping the federal subsidies to the carriers to cover the out-of-pocket medical expenses of low-income people. Next week, insurers will have to set their premiums for next year and they will have to guess what he will do and decide whether to raise their premiums sharply, shift the costs to others like your employer health plans, or just get out altogether.
But there was an amazing development last week. A half-dozen GOP senators, led by John McCain of Arizona and Lamar Alexander from Tennessee, decided to try in September to solve the problem like Congress had done the previous 225 years: by legislating with both parties. They would amend the law to make it clear that out-of-pocket costs, which were built into the act's subsidy schedule but not clearly spelled out, were a government obligation. They were talking about making other changes in the law, perhaps even including Democrats' own thoughts about fixes to the law they would have made if the filibuster threat had not blocked all alterations in the conference process in 2010.
In the House, a bipartisan group of 23 congressmen calling itself the Problem Solvers Caucus talked about the same thing.
Partnership? Compromise? Don't count on it. Disunity, hate and revenge are still the ruling passions of civil society. Just catch any day's presidential tweets.