Why Obamacare Defeated Trumpcare

With the collapse of the House health-care bill, the cause of repealing Obamacare, a right-wing obsession for seven years and a day, has died. The flame will never be fully extinguished in the hearts of the true believers — after all, in right-wing think tanks and other places far removed from electoral politics, anti-government zealots still dream of phasing out Social Security or Medicare. But the political project dedicated to restoring the pre-Obamacare status quo, in which people too sick or poor to afford their own insurance without the subsidies and regulations of the Affordable Care Act could be safely ignored, is gone forever. And it is dead for the best possible reason, the reason that undergirds all social progress: because a good idea defeated a bad one.

Conservatives have already collapsed into mutual recriminations for their failure. Reporters have blamed Trump’s deal-making skills. Trump’s loyalists are loudly blaming Paul Ryan. “I think Paul Ryan did a major disservice to President Trump … Chris Ruddy, CEO of the right-wing site Newsmax and a longtime friend of Trump’s, tells Bloomberg. David Brooks blames both Trump and Congress. “The core Republican problem is this,” he writes. “The Republicans can’t run policy-making from the White House because they have a marketing guy in charge of the factory. But they can’t run policy from Capitol Hill because it’s visionless and internally divided.”

The American Health Care Act is a truly horrendous piece of legislation. But it did not become the vehicle for the Obamacare repeal effort because Trump, or Ryan, or anybody insisted on it over some other option. It became the repeal bill because nobody in the Republican Party had a better idea.

It is true that other conservative health-care ideas do exist in the universe. It is also true that the GOP’s lack of a supermajority forced it to pursue fiscal-only repeal measures, and prevented the full rewriting of Obamacare regulations that right-wing purists would have liked. But those ideas would also have failed.

It is not possible to write a bill that meets public standards for acceptable health-insurance coverage within the parameters of conservative ideology. It is possible — just barely — to write a bill that meets public standards for acceptable health-insurance coverage within the parameters of liberal ideology. The form taken by Obama’s health-care reform will change over the decades to come. But its central triumph, creating a federal right to access to basic medical care, will never be taken away.

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