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The AHCA and the Future of Universal Health Care


There’s been a lot of discussion, including here, about Ezra Klein’s essay on how the AHCA has altered the political landscape. I mostly agree with it. While I don’t think he intended a hieghten-the-contradictions argument, though, I wish he hadn’t framed his argument as “if the AHCA passes, the Democratic Party will be committed to universal health care.” This will happen anyway, because even trying to pass the AHCA has revealed the Republican agenda to even the most stubborn apologists:

In fact, universal public insurance will be the consensus Democratic goal whether the AHCA passes or not.

The idea that the structure of ObamaCare would insulate it from political pushback was always based on a lie: that national Republicans would support good universal coverage as long as the market was involved. This has never been true. The Heritage Plan that is sometimes erroneously cited as the basic model for the Affordable Care Act was in fact a plan to replace Medicaid, Medicare, and employer-provided insurance with private insurance that would cover very little. Not only was it nothing like the ACA, in other words, it was an even more radically right-wing plan than TrumpCare. And while the legislation signed by Mitt Romney in Massachusetts was actually similar to the ACA, laws passed by supermajorities of New England Democrats tell us absolutely nothing about what national Republicans support.

Whatever Republicans pretend to believe when it looks like Democrats might be able to pass something, the actual Republican response to the uninsured has always been “tough luck.” The AHCA should stop the denial on this point, and make it clear that the Democrats should forget trying to pass legislation that Republicans can live with and just pass the best legislation they can, which means expanding public insurance as much as possible.

I’ve been howling into the void about this for a long time, but the idea that the ACA was based on “Republican ideas” is not just a lie, it’s an incredibly pernicious lie that has been very useful to the Republican Party. “We want what Democrats want, just with more market and a pony” has been the Republican line since the ACA was proposed. It’s finally been revealed as the bullshit it always was, but why so many liberals were happy to assist their con has always baffled me.

Stopping the AHCA is important, because progress will be a lot easier from the ACA’s Medicaid and tax baseline. Another thing to keep in mind is that while a lot of people act as if having a presidential nominee who favors universal health care is most of the battle, it’s more like 5% of the battle. Getting the consensus necessary to expand public insurance with an eye to universal health care means, inter alia, not preemptively rejecting converts:

First, supporters of universal health care need to be willing to take “yes” for an answer. Two potential Democratic nominees in 2020, Bernie Sanders and Kirsten Gillibrand, favored Medicare For All even before Obama was elected. This is definitely a point in their favor. But what is even more important is creating a norm in which every viable Democratic nominee is committed to universal public insurance. After all, a situation in which the president supports single-payer and 30 Democratic senators don’t like it will not produce single-payer. The left of the party has always favored universal health care, but it’s not enough. Major legislation requires a consensus.

If Congress is ever going to pass universal health care, or even take major steps in that direction, converts are going to be necessary. They should be accepted — and then held to their promises. Klein’s reporting suggests that more and more moderates are realizing that market-based compromises were a sucker’s bet, and this trend needs to continue.

The best outcome for universal health care would be Republicans trying and failing to gut the ACA. I’m increasingly pessimistic, but everything that can be done to stop it should be.


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