Republicans Will Never Find a Health Care Replacement – The American Prospect
Credit: J. Scott Applewhite / AP PhotoRepublicans Will Never Find a Health Care Replacement
The GOP is too wedded to free markets and scornful of the welfare state to ever make anything in health care work.
by Ryan Cooper, November 18, 2025
Republicans, for once, are sounding downright squeamish about onrushing massive cuts to Obamacare subsidies, with premiums on the exchanges expected to more than double on average starting next year. GOP House committee chairs are reportedly having some “brainstorming sessions” about what to do, and House Speaker Mike Johnson claims that they will “be rolling out some of those ideas” at some point.
So far, the genius idea in the lead is Trump’s pitch to reroute subsidies from health insurance companies to the American people, so they can buy health care. (House Republicans have already filed a bill that looks like this.) When asked whether people wouldn’t then just use that money to buy health insurance, Trump replied, “Ahh … some may. I mean, they’ll be negotiating prices.” Congratulations, folks, you now get to be your own private dealmaker with the health care system, and with your purchasing power and risk pool of one household, I’m sure you’ll get the best price!
The stupidity is the point. For decades now, the Republican Party has been dedicated to the proposition that rich people are too highly taxed and the working and middle classes get too many benefits from the government. With the passage of the One Big Beautiful Bill, they have finally caught the car. Medicaid and Obamacare have been slashed to free up budget headroom for tax cuts heavily slanted to the wealthy. Republicans don’t have a “health care plan” per se because this is their plan: to take your health care funding and give it to Elon Musk, Donald Trump, and the rest of the fascist billionaire class.
American conservatism is a strange political beast. Like all conservatisms across the world, it stands in defense of hierarchy and privilege, but it is welded clumsily to 19th-century orthodox capitalism. By this view, all income should come from working or owning property, and all goods and services should be obtained through the market. It would be unjust for anyone to receive a welfare benefit from the government, because they did not work to earn it. This is a philosophical problem for conservatism, as George Scialabba writes, because capitalism regularly and wildly disrupts the established social order as technologies and businesses evolve. (For the record, this view is also very stupid.)
But it’s a much more practical problem for a Republican trying to write a health care policy. Health insurance is straightforwardly impossible to square with capitalist morality for reasons a child can understand. Most obviously, people routinely get very sick or injured through no fault of their own, and require care that is far more expensive than they can afford out of pocket. Sometimes people have chronic conditions that cost many multiples of what they could ever possibly earn. Therefore, unlike the market for car or home insurance, where each person is charged exactly what they are statistically expected to claim (plus a margin of profit), any functioning health insurance scheme must have systematic transfers from the young and healthy to the elderly and sick.
With a pure market approach, only the very rich will be able to get all the health care they need. Even people making well into six figures will not be able to afford elaborate surgery or cutting-edge therapies out of pocket. The poor—or really anyone living paycheck to paycheck—will not get health care at all. Before Obamacare, that was the reality for many, with the only “insurance” available on the market being de facto worthless if you ever actually needed it.
This is what led early socialists and social democrats to advocate for national health insurance, run by the government. If the market is a fundamentally stupid way to pay for medical treatment, then throw everyone onto the same program, and fund it out of taxes. That way, the risk pool and the funding base will be as large as possible, people will be charged based on their ability to pay, and all citizens will be permanently insured. And historically, the fact that both the elderly and the poor were largely uninsured up through the early 1960s was a major motivation for the creation of Medicare and Medicaid.
Republicans have hated Medicare and Medicaid since the moment they were proposed, because they’re welfare programs. Ronald Reagan got his start in politics with an unhinged mini-documentary claiming Medicare would lead to a totalitarian dictatorship. Historically, Medicare has been too politically secure to touch—at least for now—but Republicans finally took a trillion-dollar bite out of Medicaid in the One Big Beautiful Bill.
Editor’s Note: Featured top image by WP AI.
Continue/Read Original Article Here: Republicans Will Never Find a Health Care Replacement – The American Prospect
#aca #gop #healthCare #healthSubsidies #houseSpeaker #medicaid #medicare #mikeJohnson #noHealthCareReplacement #obamacare #republicans #ryanCooper #theAmericanProspect #welfarePrograms
It’s encouraging on many levels: New York City didn’t submit to a campaign of flagrant bigotry from disgraced two-time loser Andrew Cuomo, and Americans, particularly young ones, can still be politically inspired by a good candidate with a good message.
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As #RyanCooper writes for *#TheAmericanProspect*, Merck's argument is that the "fair market" value of its drugs can only be discovered if its single largest customer - Medicare - simply pays whatever Merck demands of it:
https://prospect.org/health/2023-06-08-merck-negotiating-drug-prices-unconstitutional/
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https://prospect.org/economy/2023-05-25-democrats-fear-supreme-court/
If Biden does something about the debt default, and the Supremes block it, then the default is *their* fault. What's more, it's a mess they absolutely do *not* want to get into, like deciding which of the US's creditors will and won't get paid when they sue over the default.
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But the Child Tax Credit has been systematically sabotaged, by Intuit lobbyists, who successfully added layer after layer of red tape - needless complexity that makes it nearly impossible to claim the credit without expert help - from the likes of Intuit:
https://pluralistic.net/2021/06/29/three-times-is-enemy-action/#ctc
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https://prospect.org/economy/2023-05-17-irs-takes-welcome-step-20th-century/
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5-3-23 Nicole Sandler Show – Debt Ceiling Debacle with Ryan Cooper
Click the player above to play, right click the download button below to download the episode, scroll down for the video version
As we lurch ever closer to X-Date - the day when the US government can no longer use extraordin
https://nicolesandler.com/5-3-23/
#Nicole'sBlog #debtceiling #RyanCooper
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