The collapse of Senate Republicans' resolve to repeal Obamacare has made it clear that we are on the road to socialized health insurance, and Republicans don't seem up to the task of stopping it.
After the collapse of their latest efforts in the Senate, the task remains unchanged. It is not to postpone single payer by propping up insurers, but to build an exit ramp that will allow the country to get off the road it's on.
A bad Republican bill that ratifies Obamacare, which is what centrists such as Sen. Susan Collins, R-Maine, seem to want, is the opposite of what is needed. A system that gives a bipartisan stamp to Obamacare's market dysfunction and, worse, contains yet more subsidies and regulation will destroy the private health insurance market.
Nor is it advisable to do as President Trump suggests and simply "let Obamacare fail." Such an approach would endanger the survival of private insurers immediately. It would probably lead to big bailouts and more, not less, government involvement.
That's what happened last decade with financial services. Who wants a Dodd-Frank law for health insurance? The answer, of course, is the Democrats, for it would hasten the day when the nation has a single-payer, that is federal, socialist, healthcare system. It would have been midwived by Congress in the classic pattern of big government creating problems with one hand and then "solving" them with the other.
The dangers of such a one-two punch from Congress is even greater if lawmakers simply repeal Obamacare without replacing it with a system that works. There would be chaos and the volume of cries would get louder and louder for government to take over.
Republicans, haplessly, failed to use the past seven years in opposition crafting a free-market healthcare reform. They should have made the case against Obamacare's system, which is to redistribute money and foist a ruinous safety-net system on private insurance companies and their customers.
It's time to start from square one. If they ever get another shot at healthcare reform, Republicans must write a bill that creates what's always been lacking: enough space for markets to operate freely, offering choice, and lowering costs.
The original draft of the Consumer Freedom Amendment by Sens. Ted Cruz and Mike Lee was a real effort toward this end. It would have allowed insurers to sell plans exempt from Obamacare regulations as long as they also sold Obamacare-compliant plans as well. This would have resulted in an actual market for low-risk or medium-risk patients, separated from a taxpayer-funded safety net for high-risk patients.
We must hope we have not missed the last exit from the road to single-payer healthcare, which would be a disaster. This is especially true for those who now have good employer-based insurance. There are clear lessons to be learned from other nations with single-payer systems, and from our own dreadful single-payer systems, such as Medicaid and Veterans' Affairs.
These make financial burdens lighter for individuals, but they also result in long waiting lists, essentially rationing care so tightly that people die before they a treated. Americans should not tolerate such as system.
As the VA healthcare scandals demonstrate, single-payer systems also tend to create perverse incentives for a bureaucracy that does not care much about patients' well-being. There is an obvious reason why wealthy foreigners come to America from countries with socialized medicine when they need treatment for serious maladies.
Good healthcare is expensive, as California lawmakers learned when they tried to mark up legislation for a statewide single-payer program, only to find that it would cost more than their state's entire budget.
The only way for the United States to avoid losing its high-quality care while fixing the dysfunctional payment system that people hate is to create space for markets to operate. This must be done step-by-step. The first obvious step is to separate private insurance from the safety net for hard cases. Republicans need to set out on that path as quickly as they can.