Asked about his Bay of Pigs fiasco, President John F. Kennedy responded, "Victory has 100 fathers and defeat is an orphan." The opposite is true for the latest iteration of the GOP healthcare bill, which would have eliminated insurance coverage for more than 20 million people.
Here are the eight major reasons why the effort to replace Obamacare has so far come up empty:
1. According to a Pew Research poll conducted earlier this year, 60% of Americans, including 52% of Republicans earning below $30,000 a year, believe the government is responsible for ensuring all Americans have health insurance. Just 38% say it is not the government's responsibility.
2. The GOP leadership pursued an ideologically driven agenda to dramatically cut back Medicaid, not just eliminate its expansion. The program now covers 74 million Americans and is vital to rural and small town America-the heart of the GOP base. For at least one Republican moderate, and no doubt several more before a vote took place, that was simply unacceptable.
3. The GOP claims that their plan offered an affordable alternative for people without employer-based coverage simply wasn't credible. It raised rates on older workers and the "skinny" plans enabled by the Cruz amendment wouldn't provide meaningful coverage.
4. Moderates and conservatives in the GOP couldn't unite on a conservative alternative to Obamacare because Obamacare is the conservative alternative to single-payer health insurance, the long-time goal of many Democrats. It relied on subsidized private insurance to achieve universal coverage and used Medicaid as it was originally intended-as a backstop for the working poor who cannot afford even minimal out-of-pocket costs.
5. The plan's architects ignored how it would harm the healthcare delivery system. Both the House and Senate bills would have led to more emergency room care, more uncompensated care, and more cost-shifting to employer-based plans. Passage would have undermined all efforts at controlling healthcare costs other than stinting on care.
6. Every segment of the healthcare industry other than the drug and device sectors were highly vocal opponents of the bill. When considering legislation that affects 18% of the U.S. economy, it's never wise to ignore the concerns of the organizations and the 15 million workers who make up the sector.
7. Believing their own lies about how the Affordable Care Act was crafted, the GOP House and Senate leadership pounded out legislative drafts in secret without the normal legislative give-and-take that would identify flaws and hammer out compromises. The Republicans didn't need Democratic votes. But they badly needed Democratic ideas.
8. The bills as drafted represented a fundamental shift in GOP philosophy going back more than half a century. The GOP, prior to the tea party arriving on the scene, had always backed expanding health coverage, not cutting it back. President Donald Trump will go down in history as the first sitting U.S. president to propose a major cutback in health insurance coverage.
But the campaign to repeal Obama-care didn't end with the defection of two more GOP senators; the current Senate and House leaders have too much political capital invested in getting something passed that they can call "repeal and replace." But it's now clear they will never craft something that can please both their conservative and moderate members. That means they'll need Democratic votes to get something passed.
They have several cudgels to line up those votes. Obamacare backers recognize there are flaws in the insurance exchanges. There will be votes later this year to raise the debt ceiling, reauthorize the Children's Health Insurance Program and pass a budget, without which the government will shut down.
Each vote will present the party that controls the White House and Congress with an opportunity to craft major changes to the nation's healthcare financing and delivery systems. This drama is far from over.
