Apr 1, 2017 6 min read

Speaker of the House Paul Ryan said it best: “Being against things was easy to do.”

He was speaking in the aftermath of the Republican health care debacle. Brought to a boil by the tea party, the Republicans had for seven years organized, protested, rallied, marched, wailed, and gnashed their teeth over the Affordable Care Act, President Barack Obama’s attempt to provide health care coverage for all Americans. They vowed to repeal it and even held dozens of meaningless trial repeal votes. However, so blind were they in their hatred of Obama and this health care law that all they thought of was its repeal. They never gave a thought to producing a better health care plan for the American people. Maybe this lack of consideration for a new plan explains what otherwise would be inexplicable, that President Trump and the Republican-controlled Congress failed to do what they had vowed to for all those years. Given the opportunity to repeal and replace it with a plan of their own, the Republicans allowed the ACA to stand as the law of the land.

And how fortunate for health care in America that they did. The quickly constructed and poorly considered replacement for the ACA that the Republicans created would have stripped health care coverage from millions of people and would have caused lasting damage to both patients and hospitals.

President Trump and Ryan’s original bill was bad enough. It not only would have taken away coverage for many, but it would have also reduced covered services, and caused premiums to rise, especially for older Americans. However, the legislation got even worse. In a desperate, last-ditch effort to persuade the far-right wing of the party to get on board, Trump offered to further eviscerate the bill by removing patient coverage for mental-health treatment, emergency room visits, and preventative care. Recognizing just how bad this plan had become, Vice President Mike Pence warned Trump not to allow his name to be associated with it, but instead to dub it “Ryancare.”

At this point, a handful of moderate Republicans stepped forward to say that they would not support this health care plan that was effectively a “no care” plan. They told Ryan that they would be embarrassed to go home and face their constituents having repealed the ACA and replaced it with the NCA – the No Care Act.

Still unable to coerce the far-right wing of the GOP and now facing rebellion from a few moderate members, Trump and Ryan decided to pull the bill rather than feel the even greater sting of a floor vote defeat. Not even Fox News could paint a happy face on this disaster, its pundits having a hard time disguising their disbelief and disappointment, and searching desperately for someone to blame besides Trump.

So where does the blame lie? There is plenty to go around. It starts with Trump, who is more interested in showmanship than crafting a health care plan that would truly benefit the American people. Trump reportedly had little understanding of what was in the bill. After all, he did say, “Who knew health care could be so complicated?” True, he was elected by only a minority of American voters, but he now holds the office of president and he owes it to all Americans to think seriously about legislation that will affect their lives in such an important way. The deep-seated narcissism that Trump displays leads me to fear that he is unable to give much consideration to the needs of others, but it has been said that the office can change the man. One can only hope.

The extreme right wing of the Republican party who have destroyed bipartisanship in this country by making “compromise” a dirty word bear a great deal of the blame. As one Republican congressman put it, “These guys would vote against the Ten Commandments.” To cease being the party of “no” and to learn how to lead and effectively legislate again, the Republicans have to learn how to manage this radical minority in their party. If they continue to allow the tail to wag the dog, they will see more of their proposals go down to embarrassing defeat. Ryan appears to recognize this and my thoughts are with him as he attempts to navigate these difficult waters. This country needs a reasonable, competent, functional conservative party again.

My advice to Trump and the Republicans who control Congress is this: The ACA is a start. It provided an important precedent that pre-existing illnesses should not prevent people from obtaining health care coverage. This was a godsend for patients. It recognized that there are hard-working Americans who cannot afford health coverage and gave them an avenue for obtaining this. It greatly reduced the number of uninsured patients for whom hospitals care, thus allowing them to become more financially sound and better able to provide the new and innovative services that they continue to offer to our community.

It is not a perfect law. How many are? It needs improvement. But contrary to what Trump tweeted in the aftermath of his legislative defeat, the ACA is not failing. The independent Congressional Budget Office reports that the ACA is actually doing OK. In a majority of the country, it continues to offer Americans three or more reasonably affordable health care plans. In many areas, it has actually reduced the health care premiums that employers pay due to increased competition and the removal of pre-existing conditions as consideration for coverage. But if they truly believe it is failing, then double shame on Trump and the Republican-led House if they are so irresponsible as to be willing to stand by and watch health care coverage collapse on the American people for their own political gain.

But my hope is that Trump will now recognize all of this and begin to work with both Democrats and Republicans to improve the ACA for all Americans. I hope the Republicans can get past their hatred of a man who is no longer president, a man who had the audacity to believe that health care should be a right, not a privilege. To our own local congressional representatives, I ask you whether you believe that health care in the United States in the 21st century is a right or a privilege? If your answer is the former, then get to work on improving the Affordable Care Act or create a worthwhile replacement.

Landenwitsch is a family doctor in private practice at Claysville Family Practice, and the co-owner of Claysville Family Practice and Complete Family Care in McMurray.