The Republicans' mantra on repealing Obamacare is that government has no business meddling in the health care of Americans.
No regulation. No mandates. No subsidies. But it's based on a big fat lie. Washington has had its hands – and money – all over U.S. health care since at least the mid-1960s.
Long before Barack Obama came along, government was deeply invested in U.S. health care. Tax-funded expenditures accounted for nearly two-thirds of U.S. health spending, according a 2016 report in the American Journal of Public Health. The figure includes direct spending – through Medicare, Medicaid and veterans benefits – as well as various state and federal tax breaks. Indeed, per capita government health-care spending is higher in the United States than in many countries with universal health-care regimes, such as Canada.
If you are an American age 65 or older, poor or disabled, chances are you have a form of universal health care.
Senate Republicans postponed a vote this week on repealing Mr. Obama's Affordable Care Act until after the July 4 congressional break, as they war amongst themselves on whether their replacement bill is too generous to the poor or not giving enough.
Both the U.S. Senate and House bills would cut the federal Medicaid program, a health-insurance plan for low-income children, adults, seniors and people with disabilities. It covers one in five and cost the government $545-billion (U.S.) in 2015.
Meanwhile, Washington's largest health-care program is the similar-sounding Medicare, a health-insurance plan for the roughly 57 million Americans age 65 and older. It pays for hospital and doctor visits, prescription drugs and acute care and cost $646-billion in 2015.
Universal health care is a reality for more than a quarter of Americans. Seniors, the poor and disabled are covered.
Those who want to get rid of Obamacare – and scale back Medicaid – rarely mention Medicare. That's because the right to government health care at age 65, regardless of income, is as ingrained in the U.S. psyche as baseball and apple pie. Seventy-seven per cent of Americans say the program is "very important" to them, making it more popular among government programs than public schools and the military, according to a 2015 poll.
The notion that Obamacare is a massive intrusion of government into the health-care system isn't true. Its rollback would not hand it all back to the private sector – because Medicare and Medicaid will live on.
President Donald Trump, whose views on health care have fluctuated wildly, is now committed to the Republican plan. Spokeswoman Kellyanne Conway complained recently that Obamacare had inappropriately extended Medicaid to people well above the poverty line.
"Obamacare took Medicaid, which was designed to help the poor, the needy, the sick, disabled, also children and pregnant women, it took it and went way above the poverty line to many able-bodied Americans," she told ABC News. "If they are able-bodied and they want to work, then they'll have employer-sponsored benefits like you and I do."
The numbers show otherwise. Roughly 60 per cent of able-bodied Americans receiving Medicaid are part of the working poor. They have jobs, but not ones that offer health insurance – a key gap Obamacare aimed to fix.
The Senate bill, however, would slash taxes for the wealthiest of Americans and companies, and pay for those breaks by taking hundreds of billions of dollars out of Medicaid for the poor.
The United States has one of the most expensive health-care regimes anywhere in the developed world. Spending accounted for 17.8 per cent of GDP in 2015, compared with 11 per cent in Canada. But it's not clear it's the poor who are exploiting the system.
Medicare expenses will grow faster than Medicaid costs between now and 2025 – largely because of the greying population, according to government projections.
Critics shouldn't blame rising health-care costs solely on government schemes. More significant are steeply rising private insurance premiums and a consolidation of health-care providers and hospitals, which has pushed prices of many services well above the rate of inflation.
Until Republicans realize how attached Americans are to the idea of expanded universal health care, efforts to repeal Obamacare will clash with the public mood.