For the foreseeable future, don’t expect sensible health care reform in America.

For the foreseeable future, we’re not going to see sensible health care reform in U.S.

Congressman Kevin Brady, the Republican who represents The Woodlands area and who chairs the powerful House Ways and Means Committee, is among the more congenial elected officials, with both his constituents and the media. But even the mild-mannered former chamber of commerce executive seems a bit touchy these days as he assumes the task of defending his handiwork — a hugely complicated package of health care legislation that seeks to consign the Affordable Care Act to the garbage heap of American history, while replacing it with a plan that deprives some 24 million Americans of their health insurance, even as it increases their costs, inflicts harm on the insurance market and offers up an enormous tax cut to the rich. That’s the sort of task that would leave any of us outof-sorts.

Brady, of course, doesn’t see the new Republican health care plan as anything but a vast improvement over the hated Obamacare. “We’re returning control to states and individuals rather than Washington,” he told the Chronicle editorial board last week.

Still, the Texas congressman is having trouble selling the American Health Care Act, even to a cadre of his fellow GOP House members, primarily because they want it to go even further in its decimation of Obamacare. Another group of relatively moderate Republicans in the Senate are wary of undoing the ACA’s expansion of Medicaid and sentencing millions of Americans to the heavy burden of health insecurity they thought they had escaped.

President Donald Trump contends that he’s been twisting Republican arms, even though Trumpcare is a long way from fulfilling his promise to Americans that the Obamacare replacement would provide “insurance for everybody” and that it will be “much less expensive and much better.” As with much the president says, he doesn’t much care about the details; he merely wants an accomplishment to bray about, even though the Americans who stand to lose the most represent his core support.

Reluctant Republicans may knuckle under to the supersalesman in the White House, but lower-income consumers and older people in particular are likely to lose coverage under Trumpcare. According to AARP, a 55-year-old making $25,000 a year would end up paying an additional $3,600 a year for coverage. A 64-year-old making $15,000 would pay $8,400 a year more. Meanwhile, the muchdiscussed Congressional Budget Office analysis estimates that a fifth of the non-elderly population would be uninsured by 2026, nearly double the current proportion.

Brady and his fellow Republicans are proud that they’re returning health care to the free market. Even though the “market” for health care is like no other, they’re confident that selling insurance across state lines, consumer choice and state control of block grants will eventually provide not only $330 billion in savings but also, in Brady’s words, “much better coverage of usable, affordable health care.”

We’re not so confident. We see millions of Americans continuing to struggle with the rising costs of health care. We see a rise in the number of uninsured, increased costs for hospitals and a destablized insurance industry.

A healthier body politic would surrender to the basic fact that the health care market is different. As almost all western democracies acknowledge, health care competition is not a magic elixer. Lawmakers interested in crafting a “usable, affordable” health care plan would expand Medicare and Medicaid and create a public option for everyone else. They would champion regulatory reforms to lower drug prices and give Medicare the power to negotiate prescription drug prices. And they would offer strong incentives to encourage preventive care.

For the foreseeable future we’re not going to see sensible health care reform. As Brady and his colleagues rush through their destructive Obamacare replacement, we can only hope that it displeases so many individuals and special interests that it veers into a legislative ditch and breaks apart. Maybe someday, a bipartisan group of lawmakers will dare try again to craft a plan that provides “insurance for everybody,” a plan that will truly be “much less expensive and much better.” Despite the local congressman’s best efforts, we’re not there yet.