US healthcare reform is on life support

Why is it so difficult for the Republicans to replace Obamacare? Edward Luce reasons that Obamacare is very conservative, and there are no viable conservative alternatives available. During the campaign, I recall that Donald Trump promised to replace Obamacare with a single-payer system, like Medicare in Canada, or the National Health Service in Scotland, but I haven’t heard any support from him for this option since taking office. For that matter, Medicare, Medicaid and the Veterans Administration in the USA are single-payer programmes, so I don’t understand why a single-payer option is anathema to Republicans.

The dilemma is that Republican lawmakers can only agree on the first half of their vow to “repeal and replace” Obamacare. The difficulty with the “replace” portion is that there are no viable conservative healthcare options available. Obamacare itself was a conservative reform. Its key tenets were based on a plan drawn up in the 1990s by the conservative Heritage Foundation as an alternative to the more dirigiste “Hillarycare” — the failed reform effort championed by Hillary Clinton, then first lady. The Heritage Plan then became “Romneycare”, which was enacted in 2006 by Mitt Romney, the then Massachusetts governor.

Obamacare is based on the same principle that individuals buy healthcare policies from private insurance companies on market-based exchanges. It would be hard to come up with something more free market than that.

Edward Luce, “Republican ‘kamikaze’ healthcare plan on life support“, Financial Times, 11 July 2017 (gated paywall).

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