Today’s Affordable Care Act is very similar to the privatized mandate plan the Republicans pushed for 40 years. President Barack Obama — as a compromise to have basic health reform passed — used this same GOP blueprint with one significant change: adding a public option alongside the GOP’s privatized mandate plan (basically, Obama proposed adding an option to join a form of Medicare).

Eventually the public option was stripped out of the 2010 ACA bill in further compromise to attract bipartisan support for the bill, leaving in its place the very plan that the GOP wanted and pushed for decades. Unfortunately, the ACA did not receive a single vote from the Republican Party that created the plan’s primary concepts as alternative to a single-payer — “Medicare for all” — type of system.

As a result, the GOP’s repeal and replace position backs it into a challenging corner. It has no real replacement plan because the ACA is essentially the privatized mandate it has pursued for so many years. The only possible alternative to a 40-year-old GOP plan would be reverting to the old system, leaving millions of people without full coverage or proper health care. Even those with coverage — perhaps through their employers — could then once again have a cap on lifesaving treatments, such as those for cancer, and thereby reinstating the privatized insurance “panels” deciding the profitability of patient treatment versus patient outcomes.

Since the Republicans will not likely propose a single-payer program, that only leaves tweaking the current Obamacare plan. However, if they instead repeal with no replacement they risk a collapse of the system as insurers pull out of the program with a result that could worsen the health of millions of Americans, dramatically raise health care costs and move America further away from the patient-centric health system that is so much more successful at a lower cost than those of 36 other countries.

— Michael Buxbaum, Chicago