From July 20^th:

More at the original. As I said (on the 19th), none of the Republican plans have been anything more than Obaminablecare Lite, because there are only so many ways you can utilize the private, for-profit insurance system to force coverage for everybody.

The plain fact is that about half of Republicans — including me — objects to Obysmalcare not due to the way in which it attempts to provide insurance coverage for everyone, but that the government is trying to provide health care coverage for those who cannot or will not pay for it themselves in the first place. The problem is that the other half of Republicans might hate Obumblecare but agree with the cockamamie notion that the government should be responsible for providing health care coverage, and the GOP’s electoral advantage depends in part on a significant number of people who would lose health insurance or Medicaid if the current law is repealed.

There are only two significant ways to change the laughably-named Affordable Care Act: either total repeal, with no replacement, or single-payer. Every Republican congressman and Senator knows that voting for repeal only will take away health care coverage from some of the voters who put them in office.

So, after all sorts of near-midnight twists and turns, and with threats that Republican Senators who voted against repeal of the Affordable Care Act would be targeted in their next primary elections, the Republicans needed the political cover of three sacrificial lambs they got them:

• Senator Susan Collins (R-ME), age 64, term ends January 2021;
• Senator Lisa Murkowski (R-AK), age 60, term ends January 2023; and
• Senator John McCain (R-AZ), age 80, term ends January 2023.

Senator Collins, as Patterico noted, did not lie to her constituents: in 2015, she voted against the Republican bill to repeal the Affordable Care Act. She doesn’t face the voters until 2020, and, in Maine, voting to preserve the ACA isn’t a liability. She will be 68 when she would next face the voters, and might choose to retire.

Senator Murkowski did vote for the 2015 repeal only measure, knowing it was a safe vote, because President Obama would veto it. Mrs Murkowski is in no way afraid of the voters in Alaska: in 2010, when she lost the Republican primary to TEA party candidate Joe Miller, she simply ran as a write-in candidate in the general election, and won. She will not face the voters again until 2022, at age 66.

Senator McCain did vote for the 2015 repeal only measure, knowing it was a safe vote, because President Obama would veto it. Already 80 years old, Mr McCain would not face the voters again until he is 86 years old, if he chooses to run again. Having recently been diagnosed with glioblastoma, an aggressive form of brain cancer. Standard treatment options for this tumor include chemotherapy and radiation, although even with treatment, average survival time is approximately 14 months.

In my article of the 20^th, I (reluctantly) supported a single-payer health care plan, because I admitted, to myself, that the federal guarantee of health care coverage would not be repealed. When I cross-posted that article on RedState, it received 112 comments, most of which were in opposition. But, opposition or not, I was right, because there are only a limited number of options:

1. Some form of single-payer plan, such as extending Medicare to cover all Americans;
2. Some form of guaranteed private insurance, which is how the Affordable Care Act works; or
3. Ending the federal guarantee of health care coverage.

The Republicans have already accepted that the guarantee is an established principle, so the third option has been taken off the table! That leaves us with either single-payer, or something at least similar to the ACA, and the Republicans proved unable to craft anything different enough from the ACA to both gain the necessary support and be different enough from the ACA to keep their promise to repeal it.

Well, the ACA has proved to be horribly flawed, as conservatives said it would be when it was passed. The record of the ACA is huge premium increases coupled with insurance companies losing money on ACA exchange programs, resulting in roughly a fifth of Americans who must use the exchanges to secure health insurance having only one company from which to choose. Even with that, a couple of places were looking at having no company selling ACA insurance on the exchanges, until politicians cajoled one or another to fill the void.

The ACA is failing, and will collapse completely. I have said it before: the left only sought to get something, anything, passed, to secure the federal guarantee principle. Then, when the ACA finally fails, they’ll throw up their hands and say, “See, we tried it the conservative way, using the private health insurance system, and now single-payer is the only thing left to do.” Well, with the principle established, they were right!

The time has come for Republicans to take the lead, and structure single-payer as efficiently as possible. It has to dramatically reduce malpractice claims, by restricting any damages to actual damages, and end punitive damage claims, and it has to limit coverage to American citizens, and those immigrants who both pay Medicare taxes¹ and are in the country legally.

I do not like single-payer not in the slightest; to me, it’s only advantage is that it will be less bad than the ACA or something similar. I expect health care under single-payer to get worse, to something similar to what Sachi ab Hugh described concerning Japan’s single-payer system, or with the built-in delays used by Canada and the United Kingdom, and our own Veterans Administration, to control costs. But when even the Republicans will not end the federal guarantee, we have no other realistic option.
____________________________
Cross-posted on The First Street Journal.
____________________________
¹ – This assumes that any single-payer system will be an expansion of the Medicare system. Full disclosure: I will be eligible for Medicare next April.