Today, House Republicans could begin enacting their agenda. Even before formally assuming its majority, the GOP pledged to repeal Obamacare. As they move to do that, they confront dilemmas. For one thing, they must reflect more discretion than Democratics reflected when they approved health care reform.
A wiser voice than those heard in today's debates long ago cautioned that major changes should not be imposed by slender majorities. Democrats enjoyed strong congressional majorities in 2009 and 2010. Barack Obama won the 2008 presidential election by a comfortable margin. Nevertheless, regarding Obamacare, public opinion seemed indecisive. Citizens wanted certain problems with the nation's health system addressed, but Obamacare did not appear their preferred vehicle. Significant portions of the program created a backlash. Some of the objections were legitimate; others were not.
The Times-Dispatch shares the opposition to the individual mandate. On several occasions we have explained our discomfort with a policy that permits the federal government to compel people to buy a specified product. A single-payer system that relied solely on taxes to pay for medical services probably would pass constitutional muster, although we would oppose relying on Britain's National Health Service as a model. While we dislike federal mandates in general, the concept of end-of-life consultations between patients and doctors does not offend us. Experience indicates that many people, perhaps most, want to make it clear that, if on the cusp of death, they do not want to be placed on artificial life support or sustained by so-called heroic measures. Allegations of death panels obscured the point.
Health care in the United States divides into two main issues: the care itself and payment for it. The problem relates not to care — which for the most part sets world standards — but to financing. And this is where the GOP has failed heretofore. While various reforms circulated during the era of Republican control of Congress, the party did not move decisively to address the payment challenge. The uninsured must enjoy greater access to the financial network. The sad story records that Republicans have paid attention to the issue usually after Democrats have pressed plans for an implicit federal takeover of medicine. The nation is tired of waiting. And speaking of socialized medicine, the U.S. already has such a system: Medicare.
Polls suggest an even split regarding public attitudes toward Obamacare. That strikes us as about right, although we wish it were not so. Political reality says repeal will not be enough.
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