Republican Senator Lindsey Graham told reporters last week.: “Once you say that everybody should be covered, can’t be denied coverage because they are sick—which most Americans would agree with that—you put yourself in a box. Somebody’s got to work through this problem. If we’re going to accept the proposition that you can never be denied coverage because you’ve been sick, then somebody’s got to create a system where people participate.”
The most important step in solving a problem is reaching consensus on the existence and importance of addressing the problem itself. What’s most bedeviled liberals in their efforts to address the climate change crisis, for instance, hasn’t been intractable internal disputes over whether carbon taxes are better than cap-and-trade systems, but the abject refusal of conservatives to accept that climate change is worth doing anything about at all. The same thing was true back in 2009 when Democrats embarked on health care reform. The problem to be solved was tens of millions of uninsured people who lacked the means to pay for health insurance, but Republicans largely rejected the premise altogether. Democrats thought it was critical to create a coverage guarantee, and Republicans did not. Obamacare went about increasing coverage by expanding Medicaid for the very poor, and regulating and subsidizing individual insurance markets for the working and middle classes. But its most important legacy was creating a seedbed for the coverage guarantee Lindsey Graham was talking about. Republicans didn’t identify major pre-Obamacare coverage gaps as a crisis back in 2009, but they realize they will create a crisis if they reopen them. And that is why Democrats should always heed the lesson of the debt limit standoff. If Republicans create a health insurance cliff three years into the future, Democrats can refuse to negotiate, or they can negotiate for mutually agreeable swaps, but it would be a huge error if they accepted the gop’s terms and helped Republicans dismantle the consensus they’ve built—the one “most Americans would agree with”—that nobody can be denied health coverage in the U.S.