For the last several years, Republicans have defined themselves by their hatred for the Affordable Care Act. That, however, is quickly becoming a greater challenge: "Obamacare" is not only a successful policy, it's also the most popular it's ever been. Public support for the ACA is quite a bit stronger than public support for Donald Trump, congressional Republicans, or their regressive health care alternative.
And that's led some Republicans to shift their posture a bit. Unable to win a debate over the Affordable Care Act, GOP officials have turned their attention toward a single-payer system.
Last week, for example, Sen. John Thune (R-S.D.) said, "If we don't get this done and we end up with Democratic majorities in '18, we'll have single payer. That's what we'll be dealing with." Sen. Pat Roberts (R-Kan.) added that Congress has to pass an unpopular far-right bill, no matter what, because the alternative is single payer, "and that's socialized medicine."
At yesterday's untelevised White House briefing, Press Secretary Sean Spicer seemed quite animated on the subject.
"But make no mistake about it that Obamacare is dying. And the reality, as I mentioned last week, is that, when you look at the majority of House Democrats, they support a single-payer, $32 trillion bill backed by Bernie Sanders. That's what the alternative is."It's not a question of Obamacare versus the American Health Care Act. It's a question between we need to accept that Obamacare is dead, we need to understand that the reality is that what the choice is is between putting in a system that is affordable and accessible, or a single-payer $32 trillion healthcare plan that the majority of House Democrats support."
It's a shame that White House officials struggle this badly to keep up with the basics of the debate. We know, for example, that the Affordable Care Act is neither "dying" nor "dead." It may make Trump World feel better to believe this, but for those who still take reality seriously, the claim just isn't true.
It's also a shame that Republicans no longer see the fight against the ACA as one they can win, so they find it necessary to change the subject.
But perhaps most important is the fact that Republicans, whether they realize it or not, may be inviting the one policy they hate the most.
It's often an overlooked aspect of the debate, but "Obamacare" was, in many ways, a rather conservative way to pursue reform. It's built on a model adopted by Mitt Romney and a framework crafted by the Heritage Foundation, and it relies heavily on the private marketplace.
Republicans decided, however, that this centrist, compromise model disgusted them to their core. It was, they insisted, the worst legislation in American history, and GOP lawmakers spent years holding repeal votes, knowing in advance they'd fail, as a way of registering their blinding hatred for the Democratic breakthrough.
Now that they're in power, Republicans have been given an opportunity to govern their own way on health care. No one likes to talk about it, but GOP lawmakers could've made bipartisan fixes to the Affordable Care Act, and reaped the popular rewards, but instead Republicans said what Americans really need is an alternative approach that leaves tens of millions of Americans uninsured, guts a popular Medicaid program, and leaves much of the country paying more for worse coverage.
Given a choice between this and the ACA, the American mainstream will always choose the latter. But if Republicans condemn and/or sabotage the ACA, and people are given a choice between the Republican "solution" and single payer, don't be too surprised if "the bill backed by Bernie Sanders" gains some traction.
The Pew Research Center released a report just last week that found a majority of Americans "say it is the federal government's responsibility to make sure all Americans have health care coverage. And a growing share now supports a 'single payer' approach to health insurance."
Be careful what you wish for, GOP.