A few bullet points on health care reform at the start of December…

*The brutal truth of “repeal” is that whatever the politics, every day a flat-out repeal of the ACA becomes more and more nonsensical. The status quo ante no longer exists; changing the law back to how it was in 2009 wouldn’t bring back the health care situation that existed then.

*Hey, health care wonks! I’ve been using this line about how repeal no longer makes policy sense for some time now, but while I’m confident that’s correct, I’m certainly not enough of a health care wonk to write up all the details that make a return (via repeal) to 2009 just plain gibberish — what I called the Humpty-Dumptyness of the situation. Someone want to take a crack at it?

*It’s also true, as Brian Beutler says today (and Kevin Drum said last week) that in simple political terms flat-out repeal is less and less plausible every day, with more and more people having insurance through the exchanges.

*All of which is to say that the US health care system has now been (almost) fully Obamacare-ized, and future changes will build on the ACA. That might even had been true after a GOP landslide in 2012, but it’s certainly true now.

*Which in turn means that radicals who insist that Republicans who deviate at all from the hard-line repeal message are asking those Republicans to (continue to) absent themselves from the real debate over what’s next.

*Of course, that would be less true if there really was a Republican alternative to the ACA — if “repeal and replace” had ever become a true alternative. But even so, any alternative to Obamacare will, at this point, have to build on Obamacare.

*It also means that all-or-nothing assessments of the ACA (or of Healthcare.gov) are not only inaccurate, but particularly unhelpful because nothing is really at stake in whether the law “succeeds” or “fails.” What matters is what current, Obamacare-ized health care does well, does not so well, and does badly, and what new laws/regulations/practices can help where improvements are needed.

(Yes, I did try to come up with an appropriate Humpty Dance title for this one, but alas I couldn’t make it work. Partially because I don’t mean to imply that post-ACA health care is broken; what I mean, as I hope is clear, is that the status quo ante can’t be put back together again. But mostly because I couldn’t find the right quote…I could, however, have opened with “Stop whatcha doin’ ’cause I’m about to ruin the image and the style that ya used to.”)

[Cross-posted at A plain blog about politics]

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Jonathan Bernstein is a political scientist who writes about American politics, especially the presidency, Congress, parties, and elections.