This just in. It is reported that Republicans will schedule a vote on their repeal and replace Obamacare bill tomorrow. If they do it means they think they have to votes to pass it in the House. Even if they do, the legislation will face a rough ride when it gets to the Senate. The Senate is more moderate and will likely require 60 votes to pass this legislation. There are only 52 Republican senators.
After ranting and raving against Obamacare for seven years, the Republicans find themselves in a box of their own making. One has to suspect that all that Republican opposition to Obama's singular domestic achievement, expanding health care coverage to millions of Americans who previously went without affordable health insurance, had more to do with attempts to restrict the Obama presidency to one four year term than it had to do with opposition to the health care law itself. Beating up on Obamacare was a way of beating up on Obama. But surprise! What Obamacare has done is hasten the day that ends America's hold out as the last well off democracy not to assure all of its residents the right to affordable health care.
And now that the cat is out of the bag, there is no turning back. The majority of American voters will not tolerate a return to the days when health insurance was out of reach for most Americans with preexisting conditions and Americans whose incomes were not below the poverty line, but nonetheless were not high enough that they could afford a decent health insurance policy.
The quandary that Donald Trump and the Republican party find themselves in over health care and Obamacare, is that there are really only two alternatives to ensuring that all Americans, or at least nearly all Americans, can have affordable health care coverage regardless of their personal income levels and regardless if they are healthy or sick. One of those options is what is usually referred to as the single payer system in which the middle men, the health insurance providers are cut out of the picture and we have a one payer system, in other words, Medicare for all. And no, that is not socialized medicine. Doctors and hospitals will still be private and privately owned. Doctors will still be able to form their own for profit medical groups. Doctors will still be well up in America's income hierarchy. It's just that health insurance companies will no longer be needed and will not take a cut of the action.
But a single payer system or Medicare for all is anathema to most Republicans who fear the bogus socialized medicine scare tactic. And it will not fly in America. American tradition is primarily one of getting your health insurance via your work place. But of course we see how that leaves a lot of people on the outside. So it is a second way that we need to get to where all, or at least nearly all Americans, get affordable health care, and that is to require every American to have health care insurance and to subsidize the cost of that insurance for those whose income is so low that they can't realistically afford it. Under such a mandate the required health insurance has to be defined, otherwise the requirement is meaningless as bare bones cheap plans that cover hardly anything will pass muster. And that is why Obamacare needs to have regulations that define what health insurance policies must include in their coverage.
Oh, and one of the most important sticking points is how do we ensure that those with preexisting conditions can get affordable health insurance coverage? And how do we ensure that 50+ year olds, who are more likely to use health care, are not priced out of the health insurance markets. Well there is only one straight forward way to do that. First is to require everyone to have health insurance, including young adults, who admittedly tend to be healthier and get sick less frequently, to get health insurance policies, and then to limit how much more health insurance companies can charge older adults relative to younger adults for that insurance.
In insurance parlance both of these - requiring young Americans as well as older Americans to be insured and requiring health insurers to insure the sick as well as the healthy - are what is called spreading the risks, and that allows the average cost of health insurance policies to be lower, though admittedly the young and the healthy would be able to pay less for health care coverage without these rules. But I would say to the young that that should be OK, since your mother and grandmother are older than you and they are benefiting from these rules, and more important, you yourself, if you are lucky, will be old someday. And even you, heaven forbid, may be sick one day.
Finally, as evidence that the Republican ranting and raving against Obamacare is really just political, I offer the fact that the Obamacare model of expanding health insurance coverage was really a Republican idea after all. And before it became federal law, Mitt Romney, then Republican governor of Massachusetts enacted a very similar system of health care coverage in that state.