“Tell the Truth, George. It’s the Easiest Thing to Remember.”
By 
Above: Republican health care policy, 1948-present
Lest you be complacent about TrumpCare’s potential passage, I would consider this:
“If you ask someone to give up something, there will be resentment,” said Representative Michael C. Burgess, Republican of Texas and chairman of the Energy and Commerce subcommittee on health. But, he added, “If that claims my congressional career, so be it. It will be worth it to me to have effected this change.”
On its own terms, I can’t quibble with the logic. I don’t find the argument that it would have been politically better for the Democrats not to pass the ACA very plausible, but even if it was true it’s not an argument against the decision — you win majorities so that you can do stuff. The fact that the end Burgess is willing to sacrifice his political career is to take away health care from poor and working-class and middle-class people to pay for a massive upper-class tax cut is reprehensible, but we know what Republicans are at this point. They could do this.
To return to our discussion of earlier today, I really, really don’t understand how at this late date anyone could see any political value in pretending to believe that Republicans fundamentally share the health care goals of Democrats. Occasional bouts of candor aside, the Republican strategy (especially from the White House) will be to use an avalanche of buzzwords to suggest that nothing will change for the worse. Pretending that Republicans have ever wanted to pass anything like the ACA just plays into the hands of this argument. The Democratic counterargument has to be that TrumpCare represents what Republican health care policy has always been: that the federal government should not make efforts to ensure the uninsured because the money would be better spent on upper-class tax cuts. Pretending that Republicans and Democrats share the same goals but just differ on the means plays into the fraud.
Maybe during the process that led to the ACA this pretense was necessary to reassure marginal Democrats in the Senate, I dunno — Obama and Reid got it passed so I’m not going to quibble. I’m not talking about what they did inside, they did what they had to do, I’m talking about now, from now, here and now. The claim that the ACA, or anything like the ACA, has ever been supported by national Republicans or conservatives is false, and invoking the false claim is also terrible politics. Now is a time for drawing clear distinctions. The truth isn’t always the best politics but it is this time.