Perhaps no U.S. law has been more passionately opposed by Republicans than the Affordable Care Act. For the past eight years, they have repeatedly pledged to abolish Obamacare, with the House of Representatives voting more than 50 times to repeal it. U.S. President Donald Trump took office promising to do just that. In May, after months of heated negotiations, including two failures to corral votes within their own party, House Republicans managed—barely—to pass their first real replacement, the American Health Care Act.
Despite this victory, the bill will likely face months of deliberation in the Senate, where legislators on both sides of the aisle have already deplored its hostility to the poor, the old, and the 24 million who stand to lose coverage. Yet the biggest obstacle goes beyond legislative politics. It’s the subtle but unmistakable shift in perspective that Obamacare triggered among the public: for the first time in history, most Americans—60 percent, according to a January 2017 poll by the Pew Research Center—believe that it is the government’s responsibility to ensure access to quality health care. So even though Republicans have full control of the government, they have found it acutely difficult to push through a plan that growing numbers of Americans philosophically oppose.
The most likely outcome, then, is that the efforts to repeal Obamacare will die in the Senate. If that happens, the more pressing question will become, How can the Trump administration address the very real flaws of the U.S. health-care system, improving care without taking coverage away? The answer is to fix Obamacare rather than replace it.
To accomplish this, policymakers must target the underlying problem afflicting health care in the United States: it costs far too much. Not only does the country spend much more on health care than its peers—18 percent of GDP in 2016—but that investment has failed to translate into better outcomes. The United States persistently lags behind other high-income countries on such measures as life
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