(Bloomberg View) — With the Republicans' health care bill in crisis, some have suggested they try a bipartisan approach. To understand the prospects of such a thing, recall the most important political distinction about health care: Republicans hate Obamacare, but they are mostly indifferent about the Affordable Care Act.
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Yes, I know, Obamacare is the Affordable Care Act. But it's a distinction that makes sense anyway. "Obamacare" is the most evil legislation in the history of the galaxy, featuring death panels and, well, the details get fuzzy after that, but it's definitely a disaster, one that absolutely must be fully and totally repealed. The Affordable Care Act is a complicated law that contains a wide variety of provisions, many of them traditionally supported by Republicans. No one is demanding to eliminate, say, the provisions that have encouraged the switch to digital medical records. Indeed, ever since 2013, when the law was fully implemented, "repeal" has been a nonsense idea. "Repeal" implies a return to the status quo, but that world is simply gone. Republicans could replace the current health insurance system with something very different or with something broadly similar, but they can't go back to January 2009.
That's not to say there isn't a profound difference between Republican conservatives and Democratic liberals on health care. There is! But it's one over the fundamental responsibility of government to enable (almost) everyone to have some sort of health coverage, be it private insurance, public insurance or some mix of the two. And that's an argument that Democrats appear to have won for good in 2009, and that Republicans don't even want to fight — thus Republican efforts to portray Medicaid cuts as somehow harmless and not even cuts after all. (Yes, it's a "cut" if the law is changed in order to spend less money. End of story, really.)
At any rate, while a few Republicans are willing to say publicly that it's just tough luck if people don't have any insurance, most of the party claims they're trying to cover more people, not fewer, and to provide better, cheaper coverage, as if that was the proper role of the government. As I said, the argument is to a large extent over, although whether people will actually have available, affordable coverage is up in the air whether the Republican plan passes or not.
