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The Repeal Question and National Healthcare Legislation: The Great Entitlement

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Repeal and Replace? Maintain and Enhance? Or Repeal, Pause and Listen?

For seven years one of the often-heard phrases in American politics has been, "Repeal and Replace." This week, the Senate considered yet another procedural step on the circuitous path that the repeal and replace caravan has taken since the 115th Congress opened in January of this year.

Democrat supporters of the Affordable Care Act ("ACA") have promised to do anything they can to derail the repeal and replace effort, to keep the ACA in place; almost all Republican legislators have signed on to the "Repeal and Replace" mantra while campaigning over the course of the last three election cycles, promising to toss the ACA into the legislative dustbin.

Both sides, in this instance, may be misguided in their efforts. If history is any guide, the best approach for the American people would be, "Repeal, Pause and Listen."

The United States came late to the government entitlement business compared to the industrialized nations of Western and Central Europe. Spurred by politically powerful labor movements, the occasional anarchist terrorist attack, and ultimately, the need to establish labor peace in order to support the production requirements of the First World War, Germany, France, Great Britain and other nations began offering substantial social entitlements to their citizens in the first and second decades of the 20th Century.

The United States came to the table with the Social Security Act in 1935, acting in no small part under the exigencies imposed by the Great Depression.

Social Security marked the first substantial effort to transform the pantheon of Constitutionally-guaranteed American rights from a collection of freedoms from oppressive government (think about the promises of the Bill of Rights and the post-Civil War amendments) to include a right to something, namely a guaranteed (if modest) retirement income. In the following 70 years, Social Security was joined by two other great entitlements, Medicare, signed into law by President Lyndon Johnson in 1965, and the Prescription Drug Benefit, proposed by and signed by President George W. Bush in 2003.

Finally, to complete the quartet, The Affordable Care Act was signed into law by President Barack Obama in 2009. All four of these statutes provide substantial guarantees of government-subsidized benefits to a broad range of the American people. All four represent watershed changes in the relationship between citizens, society and government. All four come with substantial price tags. But one of them has a pedigree that is at odds with the pedigrees of the other three, and that difference both explains the current turmoil in Congress (and the nation) and suggests a path toward resolving the challenge now facing the United States with regard to the Affordable Care Act.

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