Donald Trump and congressional Republicans created a political debacle for themselves by believing a set of scare stories about Obamacare that came back to haunt them. It is an object lesson in how false realities ultimately pop like soap bubbles when pricked by plain old truth.
There are five fatal fibs the GOP sold to supporters and to themselves:
Obamacare is socialistic, government-run healthcare: Actually, the ideas that led to the Affordable Care Act, or ACA, were developed in conservative think tanks in the 1990s as an alternative to a government-run, Canada-like, single-payer scheme. The testing ground for these ideas was Massachusetts under Republican Gov. Mitt Romney. It was a middle-of-the-road idea that kept the private insurance industry at the heart of healthcare, something many Democrats, such as Vermont Sen. Bernie Sanders, considered a terrible compromise.
The American people hate Obamacare: While it is true that quite a few Americans came to detest Obamacare, what they did not like was the Republican-created myth that Obamacare is onerous, oppressive and expensive. The very name Obamacare was a GOP marketing tool to make it less attractive to conservative voters. In reality, most people — especially all those in employer-run plans — were not affected much one way or another by the ACA. Many others had no idea what it really was. In interviews, some voters famously said they hated Obamacare but loved the ACA.
Obamacare will be repealed and replaced: Republicans made this promise for seven years and Trump made the same pledge throughout his campaign. When it came down to it, though, they discovered there was vast disagreement within their party about how to do it. The priority of the so-called Freedom Caucus in the House GOP was to eliminate entitlements and toss the whole healthcare mess to the states. Meanwhile, Republicans from swing districts recognized that they would put themselves in political peril if they began taking away healthcare from older people with limited means and serious medical conditions or from pregnant women or from the working poor or from young people on their parents' plans — all the people who were beneficiaries of the ACA.
The House GOP healthcare plan is what Trump promised on the campaign trail: Trump seems to have sold this big fib to himself. Even after the harsh details of House Speaker Paul D. Ryan's healthcare bill became clear, Trump continued to say it was a "beautiful plan" that would give everyone access to healthcare and end the "nightmare" of Obamacare. Talking nonsense might get you to the White House, but it doesn't guarantee you can pass legislation once you get there. Off the record, some Republican members of Congress who met with Trump said they were shocked by how ignorant he was of the bill's provisions.
Republicans speak for the American people when it comes to healthcare: Unlike Trump, the public grasped the details of the Republican scheme. In one poll, just 17% of voters favored it. That is pretty hard evidence that Republican politicians need to abandon their self-created myths about the ACA.
Here is the truth. Obamacare is far from perfect. Middle-income people in rural states have been hit especially hard by the changes that have come about in the healthcare market since the ACA was passed, but the Republican plan did nothing to help them while it took away care from millions of poor people and threatened to cause a stark erosion in the quality of coverage for many of the older working-class whites who are the heart of the Trump constituency.
Unless you are an anti-government, free-market absolutist or just a rich guy who hates paying taxes, Obamacare does not need to be repealed or replaced. It needs to be fixed. Republicans, working with Democrats (what a crazy idea that is!), should repair it, improve it, call it by whatever name they want, but stop pretending that most Americans have not already decided that healthcare is too vital not to be a right guaranteed to everyone.
Of course, that is not what will happen. Instead, insurance companies will continue to exploit the weaknesses of the ACA, Health and Human Services Secretary Tom Price will do everything possible to undermine the system as it is, and Trump will be playing golf at Mar-a-Lago until, to use the president's own term, the country's healthcare system "explodes."
"Nobody knew that healthcare could be so complicated," Trump said in a revelatory moment a month ago. It gets even more complicated when self-delusion runs so deep in a president and a political party.