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From the moment President Obama set out to reform the health care system, Republican opposition was a Terminator robot driven by boundless, remorseless determination to kill. Every single Republican in Congress opposed the bill, and Republicans<\/a> who even considered supporting something vaguely like it were ruthlessly purged<\/a>. Even after it was passed, Republicans ginned up far-fetched legal challenges, held endless votes to repeal it, and vowed not to implement it at the state level. They couldn’t be bargained with, couldn’t be reasoned with, and felt no pity.<\/p>\n The repeal machine has suffered a series of devastating blows \u00e2\u20ac\u201c the Supreme Court upholding the individual mandate, Obama\u00e2\u20ac\u2122s reelection, the decision of several Republican governors to accept the program\u00e2\u20ac\u2122s expansion of Medicaid \u00e2\u20ac\u201c and continued to lurch forward. But Governor Rick Scott\u00e2\u20ac\u2122s announcement<\/a> that he will enroll uninsured Floridians in Medicaid appears to be a real death blow, the moment the cyborg\u00e2\u20ac\u2122s head is crushed in a steel press<\/a>.<\/p>\n From the moment he appeared on the national stage, Scott seemed to be engineered to fight health care reform. The wealthy owner of a vast hospital chain that paid massive fines<\/a> for overbilling Medicare during his tenure, Scott bankrolled<\/a> an anti-reform lobby, then ran and won in 2010 on a platform<\/a> of obsessive opposition to Obamacare. He has steadfastly vowed<\/a> to turn down federal subsidies to cover his state\u00e2\u20ac\u2122s uninsured, and even concocted phony accounting assumptions<\/a> to justify his stance. Rick Scott really hates health care reform.<\/p>\n But Scott is a vulnerable incumbent in a swing state. And his refusal to accept Medicaid expansions would have left his state\u00e2\u20ac\u2122s hospitals on the hook for $2.8 billion<\/a> when uninsured Floridians show up in emergency rooms, prompting them to lobby Scott to change his mind. And so he has. For an enjoyable sampling of conservative apoplexy, try Philip Klein<\/a> (\u00e2\u20ac\u0153waving the white flag is an accurate description of Scott\u00e2\u20ac\u2122s decision,\u00e2\u20ac\u009d) Mario Loyola<\/a> (\u00e2\u20ac\u0153the most grievous blow since the Supreme Court\u00e2\u20ac\u2122s decision upholding Obamacare last year,\u00e2\u20ac\u009d) and Michael Cannon<\/a> (\u00e2\u20ac\u0153will he sell out Florida\u00e2\u20ac\u2122s job creators too?\u00e2\u20ac\u009d).<\/p>\n Cannon\u00e2\u20ac\u2122s outrage in particular is almost poignant. He has served as a health care adviser to Scott in Florida, and as a founder of the \u00e2\u20ac\u0153Anti-Universal Coverage Club<\/a>,\u00e2\u20ac\u009d lent Scott the closest link, of all the governors, to the conservative movement\u00e2\u20ac\u2122s maniacal hatred for providing health insurance to those too sick or poor to obtain it on their own. The ability of governors to turn down Medicaid funding is the last line of defense against Obamacare, and Scott\u00e2\u20ac\u2122s betrayal of the cause \u00e2\u20ac\u201c choosing the financial health of his own state\u00e2\u20ac\u2122s hospitals over the chance to deny medical care to his own state\u00e2\u20ac\u2122s poor \u00e2\u20ac\u201c lands a blow of both substantive and symbolic power.<\/p>\n We are not about to enter a new era of peace and health care love. The death struggle between liberals fighting to make health insurance a basic right and conservative fighting to prevent that is over. What\u00e2\u20ac\u2122s replacing it is a more mundane form of trench warfare. The new conservative position will come to revolve around expanding the role and prerogative of private insurance, and the liberal goal will be to strengthen regulation and help the poor and sick.<\/p>\n A glimpse of the new conservative health care line comes from former Romney adviser Avik Roy and conservative think-tank apparatchik Douglas Holtz-Eakin in a joint-bylined column<\/a>. In it, they point the way toward the future of the health care debate. Gone is the millennial struggle to preserve the dying embers of freedom. They actually allow that the central architecture of Obamacare \u00e2\u20ac\u201c the establishment of subsidized exchanges where individuals can purchase private insurance \u00e2\u20ac\u201c is an \u00e2\u20ac\u0153important concession to the private sector.\u00e2\u20ac\u009d<\/p>\n Right! It\u00e2\u20ac\u2122s a Republican-designed idea! It might have helped if Republicans had noticed this, instead of screaming about socialism, back when Obama was trying to pass the plan.<\/p>\n In any case, Roy and Holtz-Eakin argue that their discovery that Obamacare consists mainly of a free market health insurance mechanism offers conservatives a wonderful opportunity. Here their thinking grows extremely confused. The problem with Obamacare , they argue, is that the exchanges are regulated. The \u00e2\u20ac\u0153community rating\u00e2\u20ac\u009d provision, which prevents insurers from charging higher rates to people more likely to get sick, \u00e2\u20ac\u0153will dramatically increase premiums for young people.\u00e2\u20ac\u009d They propose to get rid of such regulations and turn the exchanges into a free-market paradise \u00e2\u20ac\u0153modeled on the Swiss system.\u00e2\u20ac\u009d<\/p>\n As a policy guide, this is utterly daft. Health care economist Aaron Carroll<\/a> fisks the op-ed and concludes that they have no idea at all how the Swiss system works. It\u00e2\u20ac\u2122s more<\/i> regulated than Obamacare, not less. Community rating is needed because that\u00e2\u20ac\u2122s how you make insurance affordable to sick people<\/i> \u00e2\u20ac\u201c otherwise, insurers will just sign up healthy customers.<\/p>\n But as a political roadmap, Roy and Holtz-Eakin offer what looks like the most plausible way forward for the GOP. The health insurance industry doesn\u00e2\u20ac\u2122t want the government forcing them to sell products to money-losing sick people. Insurers will want to skim the healthiest people from the pool. And conservatives don\u00e2\u20ac\u2122t like regulation. That is a perfect match of constituency and ideology.<\/p>\n So the broader struggle will never end. But the conservatives understand that the struggle to preserve \u00e2\u20ac\u0153American exceptionalism\u00e2\u20ac\u009d in health care \u00e2\u20ac\u201c America\u00e2\u20ac\u2122s standing as the sole advanced democracy without universal citizen access to medical care \u00e2\u20ac\u201c is over.<\/p>\n Read more posts by Jonathan Chait<\/a><\/p>\n Filed Under:
\n the national interest<\/a>
\n <\/strong>,politics<\/a>
\n ,obamacare<\/a>
\n ,rick scott<\/a>\n <\/p>\n