The reason Republicans can't "come together" on a repeal-and-replacement plan for Obamacare is that the American people haven't come together on what they want.

True, polls show Obamacare remains unpopular. But the various Republican replacement proposals have polled even worse. And when you break down the answers, Obamacare is unpopular-ish. Americans, for example, like the idea of preventing insurance carriers from denying coverage to people who have pre-existing conditions. Similarly, polls show that Americans like compelling an insurance company to keep a child on a parent's policy until the child is 26 years old. Americans wish to prevent insurance carriers from "discriminating" on price based on their projections of who is more likely to use health care.

When asked whether they believe "health care is a right," many polls find that a majority of Americans say yes. Once again, Obamacare was designed to continue the march toward a Canadian-style, single-payer health care system -- a type of cradle-to-grave "Medicare for all." Under so-called single-payer, the federal government becomes the insurer, eradicating private health care insurance. So "single-payer" means that every American taxpayer is paying for the insurance -- and all the overhead costs of a bloated, inefficient, bureaucratic federal government that faces no competition or incentive to be cost-efficient.

Former Democratic National Committee Chairman Howard Dean, an early advocate of the single-payer system, later said he supported the "public option" -- a federal Medicare-type insurance available for purchase. It would coexist in the marketplace with private insurance, theoretically offering the consumer a "choice" between private or government insurance.

During the 2008 presidential campaign, Dean talked about the health care proposals of Democratic candidates Barack Obama and then-Sen. Hillary Clinton: "I think while someday we may end up with a single-payer system, it's clear that we're not going to do it all at once, so I think both candidates' health care plans are a big step forward."

In other words, Obamacare was just a steppingstone along the path. The end game is the single-payer system. Obamacare was intended to fail, given the Democrats' real goal of a Canadian-style taxpayer-paid health care. Harry Reid openly said so. The Las Vegas Sun reported in 2013:

"(Senate Majority Leader Harry) Reid said he thinks the country has to 'work our way past' insurance-based health care during a Friday night appearance on Vegas PBS' program 'Nevada Week in Review.'

"'What we've done with Obamacare is have a step in the right direction, but we're far from having something that's going to work forever,' Reid said.

"When then asked by panelist Steve Sebelius whether he meant ultimately the country would have to have a health care system that abandoned insurance as the means of accessing it, Reid said: 'Yes, yes. Absolutely, yes.'"

Barack Obama, then a state senator from Illinois, said: "I happen to be a proponent of a single-payer, universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its gross national product on health care, cannot provide basic health insurance to everybody. ... A single-payer health care plan, a universal health care plan. That's what I'd like to see. But as all of you know, we may not get there immediately. Because first we've got to take back the White House, we've got to take back the Senate, and we've got to take back the House." And later, then-President Obama reiterated his stance, with the qualification that if starting "from scratch" he'd have a single-payer system.

Never mind that Claude Castonguay, the "father of Quebec Medicare," criticized his own invention, and said that the mistake was not encouraging more private-sector participation. In the '60s, Castonguay chaired a Canadian government committee on health care reform. He urged Quebec, his home province, to enact government-administered health care, paid for by all tax levies on its citizens. Quebec obliged.

Eventually the rest of Canada followed suit. But 40 years later Castonguay, serving as chairman of a government committee reviewing Quebec health care in 2008, said the system was in "crisis."

"We thought we could resolve the system's problems by rationing services or injecting massive amounts of new money into it," said Castonguay. "We are proposing to give a greater role to the private sector so that people can exercise freedom of choice." His recommendations included contracting out services to the private sector, instating co-pays to see doctors and legalizing private health care insurance. Radical stuff.

Never mind that, a year later, the newly elected president of the Canadian Medical Association said that her country's health care system was "imploding" and said, "We all agree that things are more precarious than perhaps Canadians realize." At the same time, the CMA's outgoing president said, "A health care revolution has passed us by" and "competition should be welcomed, not feared." Better late to Economics 101 than never.

The GOP took a big step this week toward fulfilling its promise to repeal and replace Obamacare by passing a procedural vote to debate the issue in the Senate.

Now comes the hard part.

COPYRIGHT 2017 LAURENCE A. ELDER

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