The United States has been moving toward universal health care coverage for all its citizens for almost fifty years now. It has occurred in stops and starts with different kinds of initiatives, but it has been on the way. Who could draw a contrast more sharply between a President Richard Nixon and First Lady Hillary Clinton? Yet in their time on the political stage they both advocated for some form of universal coverage. In the case of Clinton, her failed initiatives were resisted by Republicans who labeled such efforts as “socialized medicine.” Their alternative vision in the 1990s was something along what we have today, a hybrid of public/private coverage.
While the most progressive edge of the Democratic Party always supported a central payer option – “Medicare for All” – Republicans balanced that with insurance industry led private solutions. A hybrid plan of public/private coverage is in fact what then Governor Mitt Romney designed for his state of Massacusetts. It was so successful that Romney’s plan became one of the major templates for the Affordable Care Act, what Republicans quickly attached to the President’s name – Obamacare.
During the development/hearing phase of the Affordable Care Act, the Romney plan provided a most helpful template. In addition, Republicans added well over a hundred adopted amendments to the plan, leaning it toward the private sector. And yet when the vote was taken not one Republican voted for it. Their hybrid model had come into being, but for the sake of political statement, they had to oppose it – and spend seven years attempting to repeal it, all the while attempting to undermine and sabotage it so it would fail. But opposition is not the same as governing.
With the Republican ascendancy to control the Administration and both houses of Congress they found themselves in a very peculiar situation. The plan they were politically charged to dismantle was the very thing they would have presented as their own plan, the Romney solution. So when it came to actually presenting an alternative to Obamacare they had none, that is, none that would be acceptable. With vast ideological divisions in their own party they could not settle on a plan that was acceptable to their leadership, much less an American public that has warmed to the idea that all citizens should have real, not fake access to health care. Republican Governors and Senators heard from their constituencies. Medicaid expansion was wildly popular. The Republican plan was doomed to failure.
Ironically, Obamacare was always seen as a compromise plan for many Democrats who still held to a vision of central-payer, universal coverage, a la Canada or the United Kingdom. That position is actually gaining strength again. Ironically, Obamacare – the Romney template – was something like what the Republican Party would have developed itself.
With the failure of the Republican effort to repeal and replace comes a moment when the GOP and DEMs could collaborate on strengthening our system. Because of the need to win and prevail it is unlikely to happen. But one thing has already happened, directly and indirectly, beyond party and ideology: Americans have already come to believe that access to quality health care is a right of citizenship, not something to be enjoyed by the privileged who can afford it. That change – more significant than any bill in congress – will most likely tell the future story of real access to health care in our country, whatever form it takes.
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