The Non-Plan to Replace the ACA Isn’t Just Trump’s

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President Trump has had ridicule heaped upon him, and rightly so, for promising—for the umpteenth time, by actual count—on a telethon earlier this week that his super-duper replacement for Obamacare was ready and would soon be unveiled. As The Washington Post’s Catherine Rampell has documented, this came as news not just to telethon viewers, but also to Trump administration health policy officials, who admitted they knew of no such plan, ready or not.

In one sense, though, Trump is getting a bum rap. The failure to produce a replacement for the Affordable Care Act isn’t his alone; it’s that of the entire Republican Party and American conservative movement. During Barack Obama’s presidency, Republican representatives and senators voted dozens of times to repeal the ACA, but never once advanced a bill to replace it. Since Trump became president, that failure has only continued.

The problem lies with America’s über-capitalist brand of conservatism. The American right wants to entrust health care to private health insurance companies, which can only afford to cover people with pre-existing conditions if they get the kind of massive income boost that the ACA provided them by offering their compatriots a subsidized way to buy insurance from them. Roughly 20 million Americans now get their insurance through the ACA, and if it were repealed, not only would they lose it, but so would millions more with pre-existing conditions whom the companies would refuse to keep on their rolls at affordable rates.

Other schools of conservatism, more oriented to national solidarity than to laissez-faire capitalism, have embraced state-provided health coverage, beginning with that of Otto von Bismarck’s Germany in the 1880s. But that’s not conservatism American-style, which is why Republican elected officials, right-wing columnists, and conservative think tanks have uniformly failed to devise a replacement for the ACA, though they’ve had ten and a half years since its enactment to come up with one.

This, then, is a fish that doesn’t stink only from its comb-over head. It’s the whole body of American conservative thought that is rotten.

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