There is widespread recognition that the Affordable Care Act (Obamacare) delivered by President Obama, the Federal Government and Congress created a solution for every American to have health care.
As a European I grew up with public health care. It was superb; the NHS is one of the greatest public institutions in the world and I'm proud of it. Many people ask me why President Obama didn't pressure the Democrats to pursue the public healthcare option when he had control of both Houses.
The answer is that Obama didn't have 60 Democrat Senators. There were 58 Dems and 2 Independents - one of whom was Joe Lieberman. 59 of those people were, as best as we can tell, ready to vote for a Bill that included a public option. Joe Lieberman was not; in fact he announced he would join the Republicans in filibustering any bill that included a public option.
What President Obama and the Democratic-controlled Congress ultimately settled on was a framework of health care exchanges - marketplaces where health insurance could be purchased and has to be, if you weren't already covered.
Although they preferred a single payer system (the public option), the legislative package passed aimed to increase the quality, availability and affordability of private and public health insurance - extending coverage to over 44 million of Americans.
"We didn't give in to mistrust or to cynicism or to fear," Obama, announcing the Bill's passage that night in the East Room of the White House, said. "Instead, we proved that we are still a people capable of doing big things and tackling our biggest challenges,"
Obama opponents have had trouble accepting that this actually happened. Driven by ideology, envy and/or jealously Republican leaders have repeatedly tried to pounce on the clearly successful Affordable Care Act; the law that simply put vastly improved medical care in the United States. It has provided healthcare for millions across the country and thus driving the percentage of Americans without insurance to record lows of 9% in 2015 - reducing the uninsured rate to the lowest level ever recorded.
Insurers cannot deny coverage to anyone based on their current health status - a meaningful protection for the 133 million Americans with chronic illness. Over 15 million poor or near poor citizens are now receiving Medicaid benefits in the 31 States and the District of Columbia that had opted for Medicaid expansion.
Oh and the question of whether Medicaid expansion worked isn't even close, it vastly improved coverage. Only 13% of adults covered by Medicaid expansion are able-bodied and not working. The vast majority are low-income, hard working Americans.
If every state expanded Medicaid, which 19 states have refused to do, roughly 4 million low-income Americans would be eligible for coverage through the Medicaid expansion.
Another 3 million Americans under the age of 26 have been allowed to stay on their parents' health care plans, thanks to that provision in the Affordable Care Act.
Obamacare has also been good for health care jobs around the country, but especially for hospitals. We have seen a boon of hiring. Just last month (Feb 2017) hospitals, doctor offices and the rest of the health care industry added 26,800 jobs.
Despite all the law's successes the Republican leadership and the current Administration declared it a failure and hope to repeal it. While the law has encountered growing pains, any repeal will instantly drive up costs of healthcare and create unimaginable chaos in the lives of the newly uninsured. They will rob an estimated 24 million Americans of care, many of whom will be terrified by the idea of living without health insurance.
Paul Ryan and others in the Republicans leadership mock the idea that they're willing to let people go without care, but let's face it, if the Affordable Care Act is scrapped and replaced by American Healthcare Act that logic is unavoidable.
The biggest problem the Republicans face is that it has undeniably shifted the paradigm on the delivery of healthcare in the US. Of the 31 States that opted to expand Medicaid coverage, 16 have Republican Governors. None of these governors have expressed desire to throw their States' residents off the rolls.
Public opinion has also shifted: a Fox News poll found that overall favourability toward Obamacare has increased to 50% and only found 23% of respondents favoured fully repealing it - a new low.
The health care system in the United States is far from perfect but repealing Obamacare simply won't work. There is no measure of cruelty and foolishness that could be measured by introducing this harmful legislation, which would simply make health care less secure, less affordable and limiting it to those who can pay.
Instead of undermining Obamacare and passing something that makes thing worse, we should focus on fine-tuning it so we protect those in most need of it: the elderly, the poor, those with pre conditions. That part is not complicated - President Obama knew that.