We don’t get to just move on from the healthcare discussion

The AHCA has failed and people are frustrated and tired. The Republicans want to move on. Trump wants to move on. Some Dems want to gloat. But there is no moving on from this discussion, healthcare is too central an issue in people’s lives.

The AHCA was a political construct. It was “designed” to meet the political objectives of Trump (meet his campaign promise of doing something fast, without regard to what that was) and the political objectives of the republican leadership (destroy Obamacare without regard to how). As a piece of policy, it was harmful to most Americans, and the design of the bill and the effort to pass it were slapdash and amateurish.

It was brought down by the conservative and moderate wings of the party — the conservatives wanted more free market structuring, the moderates didn’t want to hurt their constituents.

So, now what. We have a turned a corner in this country. The Frum article (https://www.theatlantic.com/politics/archive/2017/03/the-republican-waterloo/520833/?utm_source=atlfb) and Naam’s observations about the Overton window (https://www.facebook.com/ramez.naam/posts/10154105976537493?match=b3ZlcnRvbiB3aW5kb3csb3ZlcnRvbix3aW5kb3c%3D) are useful to read. The electorate has come to expect universal coverage at a reasonable cost (which is what Trump ran on though he was just being politically expedient). Plans that rip away coverage from the poor, from children, from young mothers — those will never get through.

And inaction on costs is not acceptable. People are paying too much for healthcare today. They are mad about it. The US has the highest costs of any developed nation (https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita). Failure to address the ruinous costs borne by the middle class and working class will result in midterm loss of Republican house seats, and turnover in Democrat seats as well.

The Republican leadership (or new Republican leadership) needs to accept reality. They can’t just throw up their hands, say “darn it”, and move on to their next dream of tax reform. There is plenty of room to work on costs and improve the functioning of the ACA — see Naam’s list (http://rameznaam.com/2017/03/25/healthcare-improvements-republicans-could-make/). There is plenty of room in a system with universal basic coverage to insert market dynamics. The Republicans need to turn their attention to these opportunities. The Democrats need to lead with reasonable proposals and support reasonable efforts.

No one can walk away from the healthcare discussion.