Fiscal conservatism defines nearly all Republicans, even if decades of failed economic promises say otherwise, but the modern Republican Party is also a collective of combative factions. There are extreme social conservatives who often vote based on social wedge issues like abortion. There are moderate social conservatives who tend to go along with many social conservative positions, but who are primarily fiscal hawks. And there are extreme fiscal hawks who lean libertarian, and in many cases reject some of the more offensive tenets of social conservatism.
Over the years, Republicans have voted for a variety of Obamacare repeal bills. This time last year the repeal count was over 60. These repeal votes were red meat for their rabid base, a dog and pony show for the rest. Because Republicans knew they had the cover of an Obama veto, they never had to do the hard work. Turns out this governing thing isn’t so easy when it really matters.
You and I already know why it is not possible for Republicans to offer a healthcare plan better than Obamacare. Even if Republicans do eventually present a unified healthcare plan, and even if Republicans insist their plan is better than the Affordable Care Act (ACA), and even if you stubbornly continue to believe what Republicans say, Obamacare will still be better.
I’m one of the lucky ones: I have the skills, time and resources to analyze the situation and find the best choice for my family. I’m also lucky that I make enough money to afford the ever higher costs to insure my family. But what happens if the luck runs out?
Health care costs keep rising rapidly, and even when the Affordable Care Act fully kicks in (2014), the expectation is that cost increases, while tempered, will still be unsustainable. There are many ideas, solutions and hybrid solutions to tackle rising health care costs, but at its most fundamental level there are two approaches, and only one makes sense in the long run.
There is no question Medicare needs fixing. The biggest problem with Medicare is that it is a high-risk pool. Insurance will be expensive per person when the only people in the insurance risk pool are 65 and older or disabled. That makes it fairly remarkable that Medicare has managed to survive for as long as it has. The reason it has survived is because of a vast supply of political will and public support. But sooner or later we are going to have to address the root issue, high risk. All insurance works by having diversified risk whether it’s car insurance or health insurance. Therefore, diversifying the risk pool when it comes to Medicare means extending it to all Americans, or ‘Medicare for all’. Having one insurance payer makes the financing of health care simpler and more efficient. Removing profits from the financing side of health care means nobody is deciding what is and isn’t covered based on shareholder sentiment and CEO bonuses. Removing profits means less overhead, hence less costly health care. Fixing health care in this country means extending the same coverage your grandparents have to all Americans.
One thing that I’ve been continually mystified about is this notion of government is evil and part of the problem. This kind of rhetoric was in overdrive during the healthcare debate in 2009 and 2010. When it comes to government, you have a say! It’s by the people, for the people. Why anyone would choose to privatize (or keep private) a service that is meant to benefit all (like financing of healthcare) is perplexing to me. You, I, and all citizens have a say in our government.