Like most of us here I was disappointed when the health care reform of 2009 didn't result in a single-payer system. The disappointment was especially bitter because I expected the ACA to be a good enough bandage for health care that it would push future reform off by decades. I understood why this was all that possible in the current political landscape and remain grateful for what we did get… just disappointed.
I don't support repeal of the ACA by the GOP in any way, shape or form. People will die, real results from ideological actions. Has congress ever passed a bill that would hurt so many citizens? It boggles the mind. And it might result in single-payer.
If Ryan is able to pass Trumpcare it will be a huge but Pyrrhic victory for the rich. Wave elections happen. There is a non-zero chance that 2021 will see an inauguration of democratic majorities with a democratic president, all elected with a mandate to fix the health care disaster unleashed by Ryan. It is then that the public will be ready for the simplicity of single-payer as well as mad enough at the rich to stick them with the bill. The new Gilded Age will end just as the original — taxed and regulated due to voter anger.
Preparations for the new health care law should begin as soon as the ACA is repealed, if Ryan is successful. Congressional candidates should use the outlines of the plan in every election through 2020 so that the public is prepared, even asking for the change.
This would be a good outcome. On the whole I'd still rather have Clinton and the ACA. Too much can go wrong in four years, too many people can die and by the time Trump's through we might have bigger problems than even health care.
But if Ryan rams Trumpcare through congress and Trump doesn't start WWIII (both big ifs, but possible) we might have an opportunity to to make the greatest improvement in the American safety net since social security. This is what should keep Ryan and McConnell up late at night with dread, while the rest of us plan to storm their gates.