The new healthcare bill has to make coverage accessible to everybody

I, for one, am glad the Republican health care bill failed.

Yes, it was a work in progress. Yes, it would have been changed and amended and probably receive its final form in a House-Senate conference committee. Yes, if President Trump hadn't chosen to cluelessly and ham-handedly step in and force a vote on a bill which he was guaranteed to lose on before the process of negotiation and compromise could have even made much of a beginning of patching the holes, a better bill might conceivably have emerged.

But the bill as written was a disaster. It would have deprived huge numbers of Americans of their coverage and in the last analysis been far worse than what it replaced. Given the influence of the Crazy Right in this conference and the relative powerlessness of anybody to the left of center, I'm not sure the influences necessary to have produced an equitable bill could have been brought to bear. Yes, all things considered, maybe it's good that Paul Ryan pulled the bill, just as President Trump ineptly forced him to do when Mr. Trump decided to thump his chest even if it meant failure.

Yet Obamacare needs to be replaced. But it needs to be replaced with something better than it is, not worse. Michael Strain, writing in the Washington Post, has it exactly right: the one cardinal and in fact absolutely necessary feature of whatever replaces Obamacare is that it not only give lip service to but actually enable universal coverage.

The mandate and the inefficiencies of Obamacare are only parts of the problem. An even more serious problem is the number of middle-class Americans who are working and who may even be pulling down fairly decent incomes but still cannot afford health care. More and more insurance companies are finding it to be bad business to even be involved, and are pulling out. President Trump was overstating the case when he talked about it "imploding." But a replacement has to be found, and that replacement has to actually solve problems and not merely check off items on a list of ideologically permissible features.

Since the election, health care debates online have in my experience been largely over the silly and archaic issue of whether the Federal government has a place in healthcare. Whether on health care or elsewhere in the realm of public assistance, conservatives tend to make abstract and usually illogical constitutional arguments which confuse the Constitution's limitation of the Federal government's powers with activities and areas of involvement, They miss the point that in our modern society the Federal government is simply the only agency with the resources to even make a beginning of assisting those who for whatever reason lack the resources necessary for the pursuit of happiness which the Declaration of Independence declares to be not only a fundamental right but one which governments exist precisely to secure.

And yes, unless one wants to make the argument that people with serious illnesses who cannot work, cannot afford insurance, or are otherwise prevented from paying for minimal health care can nevertheless, somehow pursue happiness, that implies that health care is indeed a human right. And government at some level must necessarily be involved.

Conservatives generally either ignore the crucial point that the realistic options are a) that tax money is used by the government to help those who cannot help themselves, or b), in Ebeneezer Scrooge's words, "die and decrease the surplus population."  But that is, nevertheless, the basic issue here. Churches, individuals, and private charity have never in human history been able to marshall the resources to even make a beginning of doing the job, and the fact that in the past we have relied on them doesn't change the fact that the consequence of this was that most of the needs of most of those who need help were not met.

When they do acknowledge the real issue, they often say that states rather than the Federal government should administer such plans. Were this a serious proposal it would merit serious consideration. States can administer tax revenues far more efficiently than Washington can, and if there is duplication in various areas that may be the price we have to pay. The only serious objection I can make is that the preamble to the Constitution does expressly state that its purpose- and therefore that of the Federal government it establishes- is, among other things, to "promote the general welfare." At the very least, the Federal government would have not only a right but a duty to step in if an individual state drops the ball.

But those are details. We decided long ago that we were not the kind of society (no matter what ill-informed foreigners seem to think) which simply kicks the poor or others in need of help to the gutter, and recognized that, at least provisionally, the Federal government is the only agency in a position of coordinating our society's efforts to help those who help themselves. If a plan can be found through which both money and authority can be devolved to the states along with the responsibility for making sure that everyone has access to health care,, so much the better, bearing in mind even so that, insofar as the pursuit of happiness is a basic human right, being in a position to pursue it is, too, and that the Federal government, therefore, would still have an obligation to step in when the states fail to meet their responsibilities and even undertake measures to compel them to do so if necessary.

All of this is about means, not ends. I have every confidence that Paul Ryan and Mitch McConnell and whoever President Trump delegates to be the member of the administration who knows what they're talking about and helps them can work out some kind of plan that can be fair and still correct the glaring abuses of Obamacare. It is not necessary that we have a single-payer system. It is not necessary to have mandates- although it would behoove the Federal government to have some kind of tax incentives, perhaps in the form of tax credits, to strongly encourage people to participate.

But the Republican party needs to embrace the principle of universal coverage in fact, and not merely in rhetoric. Tax credits don't cut it. Every meaningful study of the likely impact of the bill just withdrawn concludes that it would result in even more people being without health insurance than are at present. Obamacare, while it may not be "imploding," is in big trouble. What is necessary at this point is a solution that will solve its problems, and not create new ones,

The bigger the role played by private enterprise, the better. To the lower the level of government involved in the more details of the plan, the better. But the GOP as a party needs to embrace and not merely give lip service to a goal which Obamacare miserably failed to achieve: making health care available to everybody,

Unless that happens, no outcome to the healthcare debate can be moral, politically viable, or socially acceptable.


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