One of the main consequences of President Obama’s reelection is that his national health care law will be implemented. Though there are various measures that Republicans can take to gum up the works in the coming years and though there will be a number of logistical hurdles facing the administration, the reality is that any future Republican proposals for reforming the health care system will have to wrestle with the existing Obamacare framework. Even if premiums spike, wait times at doctors’ offices swell, exchanges are a mess and some people lose coverage they like as a result of the law, at least some Americans will be receiving benefits, and Republicans won’t have the guts to take them away. So, after all the talk and promises over the past several years, we never did actually get to see the promised Republican legislation to “replace” Obamacare and we never will.
To be sure, during the health care debate in 2009, some Republicans offered alternative health care proposals. For instance, one was introduced by Reps. Paul Ryan and Devin Nunes along with Sens. Tom Coburn and Richard Burr. Rep. Tom Price proposed another. But at no point did Republicans unite around a single idea. This strategy had a political logic – it was easier to focus on attacking Obamacare than to offer a proposal that had no chance of passage and would open Republicans up to counterattack. It was exactly the same strategy Democrats employed to great effect during the 2005 Social Security debate. During the 2010 election, Republicans did promise to “repeal and replace” Obamacare. Though the Republican House of Representatives did vote on repeal a number of times after taking power, there has never been a vote on a replacement.
To be clear, Republicans didn’t lose the health care debate in 2009 or 2012. They lost it during the Bush era, when Republicans came to power and failed to advance free market solutions. Unlike issues like guns or taxes, there isn’t a strong activist community on the right built around health care. Such activism has only traditionally been created on an ad hoc basis to respond to Democratic efforts to expand the role of government, as with Hillarycare in 1993 and 1994, and Obamacare. As long as Republicans failed to address problems with the health care system, it was inevitable that at some point Democrats would realize their dream of national health care.
A lot of conservatives were suspicious of the idea of “replacing” Obamacare, because they viewed it as an attempt by Republicans to create a watered down version of a government-run program. That may be a reason to oppose some specific ideas, but not the whole concept of reforming the health care system. The reality is that even if Obamacare were to have been repealed, Americans still would have been stuck with the pre-Obamacare status quo: rising health care costs, a mixed government/private health care system, a tax code that discriminates against individuals purchasing insurance for themselves instead of through employers, and a raft of existing government regulations stifling choice and competition.
In the coming years, it will be important for conservatives and Republicans to avoid making the same mistake again. Though it’s now inevitable that Americans will experience Obamacare, the battle over the future of the health care system is far from over. At some point in the future, liberals will be arguing that any ongoing problems with the health care system are a result of Democrats leaving the private sector with too much control. They’ll be renewing their push for a “public option,” with the ultimate goal of achieving single-payer health care. And if Republicans don’t present compelling alternatives, that’s exactly where America will end up.