If the Republicans can't scrap Obamacare, what is the point of them?

They've had seven years to design a better replacement. During those seven years, many thoughtful free-market institutes came up with a choice of schemes that would be superior, not only to the current mess, but to the system that preceded it. There was a broad range of options to choose from – including the attractive idea of Singapore-style personal healthcare accounts. Yet, when the moment came, Republicans on the Hill fluffed it.

What were you thinking, senators? I ask the question quite sincerely. I know lots of you read the Washington Examiner: I keep seeing it in your offices. So let me say this as one elected representative to another. If you can't go back to your constituents with a better system than this one, they won't want to hear your excuses.

Inertia bias is a powerful force in human affairs. Vested interests always grow up around any system. In the case of Obamacare, those vested interests include practitioners, politicians and pharmaceutical corporations. As the months pass, it becomes harder to agree on an alternative. The great economist Milton Friedman called it "the tyranny of the status quo".

It was precisely for this reason that, over the past seven years, I repeatedly warned that, once Obamacare came into effect, it would be like an ineradicable weed – tougher to uproot than you'd imagine possible.

How did I know? Because we British have had state-run healthcare for longer than anyone can remember and, though we keep grumbling about it, no one is allowed to propose an alternative. If you do so – trust me on this – you are shouted down for "insulting our hardworking doctors and nurses."

Is our system popular because it is so efficient? No. On most measures, we are outperformed by other developed countries. The OECD, for example, ranks Britain's National Health Service well behind those of some of its poorer members, especially when it comes to the most basic measure of all: curing people. Other independent measures agree.

Only one league table puts the NHS at the top, and this is the one invariably quoted by supporters of the system. It is carried out by the Commonwealth Fund, and it measures a number of healthcare systems in wealthy countries by criteria including social equality, where the NHS naturally does well. But the survey also contains one rather sobering finding. As an otherwise gloating report on its findings in the Left-wing Guardian newspaper conceded: "The only serious black mark against the NHS was its poor record on keeping people alive."


Could Britain do better if we moved to a more commercial system? Without doubt. The tentative steps taken towards market mechanisms by the Blair government – allowing some competition in the internal procurement of services – improved outcomes by any measure. And those changes remain unpopular with producers and, therefore, with voters. After all, people are always going to trust clinicians over politicians, even when those clinicians are arguing for their own privileges.

Healthcare is, by its nature, an especially emotive issue. If a British politician proposes that this or that aspect of the NHS might be made more responsive to consumers, the reaction is likely to be, "How dare you insult our NHS! It saved my Auntie May's life!"

Logically, this is no different from saying "British Airways saved my Auntie May's life: It flew her all the way from London to New York without crashing!" But we don't say that. We expect a certain minimum level of competence from our pilots, and we understand that that expectation is a compliment rather than an insult. But, when it comes to healthcare, we apply a very different standard, feeling that any questioning of the system is somehow ungrateful.

You'll get used to it, my American friends. Three months ago, I wrote in this magazine that you had just one chance left, that Obamacare would have to be repealed now or not at all. That chance has now passed.

Donald Trump responded to the Senate defeat by saying that Obama's system would "implode". It won't. It will just get more expensive, more bureaucratic and more byzantine, and people will put up with it for want of an alternative. After a while, they'll forget that there ever was an alternative. American healthcare will become more centralized, more remote and more expensive, both in premiums and in taxes. And the blame will fall on those legislators who kept it in place.

Dan Hannan is a British Conservative MEP.