Opinion

Democrats built a health-care jalopy. But it's Republicans who are about to drive it off a cliff.

It's pretty clear who to blame when it explodes

The immense, wobbling Jenga tower that is the American health-care system has gotten a few more jostles lately. There are more problems with some ObamaCare exchanges, with more insurers withdrawing from the marketplace. Some locations now have only one or two options on their exchange — while a few have none at all. Other insurers are planning gigantic premium increases.

What's the problem? Some of the insurance markets are troubled by greater than expected costs and low enrollment. Others are worried by Trump's erratic threats to remove insurer subsidies, as my colleague Jeff Spross explains. Still more are concerned about the very prospect of TrumpCare, which is before the Senate and could do untold damage to the delicate exchange system if it becomes law.

But one thing is clear: Whatever happens to American health care, it is now Republicans' fault. If American want better health care, they must vote against the GOP — and not just in favor of any Democrats, but ones who support Medicare for all.

Of course, Democrats are responsible in many ways for setting up these problems. If it weren't for Joe Lieberman (and other treacherous centrist Democrats), there would be a public option as a backstop for places without any private exchange insurers. But as Ezra Klein pointed out in 2009, Lieberman (hilariously, now up to replace James Comey as FBI director under President Trump) demanded no public option as his price for voting for ObamaCare, so he could get back at the liberals who primaried him in 2006. I hope the harvest of sick and dead people is sufficiently large to satisfy him.

But the fact that Democrats are the author of some problems has nothing to do with the ability of Republicans to fix those problems. The GOP has control of the House, the Senate, and the White House. The filibuster is an obstacle only insofar as Senate Republicans allow it to be. They could abolish it at a stroke, with a party-line vote — or simply replace the parliamentarian with one that will approve the rules they want, which they have done before. Indeed, if they had a credible proposal to actually improve ObamaCare, they could probably peel off enough Democrats to pass it.

And they may well pass something! But when we look at Republican health policy proposals, it is obvious they have no intention whatsoever of fixing the problems with American health care. On the contrary, they are going to make them all worse. ObamaCare subsidies will be slashed and coverage requirements will be cored out in many states — cheaper premiums in some places for some people, but at the cost of skyrocketing deductibles and less treatment covered. And Medicaid will be slowly strangled to death. It's a disaster for all but the very rich.

This brings me back to the Democrats. Virtually no one wants TrumpCare. But many people are understandably rather skeptical of Democrats when it comes to insuring every single person. To this day there are still 28 million people uninsured, and a lot of the coverage on the ObamaCare exchanges is lousy, with sky-high deductibles and massive out-of-network bills. It's better than the previous status quo, but it's a long way from true universal coverage.

During the negotiations in 2009, ObamaCare was viewed as a sort of permanent compromise between the left-wing dream of universal health care, and the fact that private insurers and medical providers have sunk deep roots in the country (including into many Democratic members of Congress). With a hybrid system, we could cover everyone without having to delete the entire private insurance industry. It was a (theoretically) universal system that could accommodate conservative market ideology.

It's clear now that idea was totally mistaken. The compromise did not ever take hold; Republicans hysterically demonized ObamaCare as something akin to the Great Leap Forward or the Holodomor from the moment it was proposed. And now that they have taken power, they move to not just scrap most of ObamaCare, but actually worsen coverage as compared to the pre-ObamaCare status quo. The only disagreement is about how much worse it will be.

So Americans who want everyone to have insurance — not to mention an end to the infuriating paperwork, the impossible deductibles and co-pays, and the bankrupting medical bills — must demand Democratic candidates that will vote through Medicare for all. Meanwhile, Democrats must realize that if they are to keep power after winning another election, they must ram through fundamental, brute-force reform — one that will quickly and easily hand people simple coverage that is unequivocally better than what they have.

Tinkering around the edge of the American health-care monstrosity is not going to cut it this time.

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