January 5, 2017
The critical moment has arrived. The Republican Party will now have control of both Congress and the White House, and is poised to achieve its number one policy objective: the repeal of the Affordable Care Act (ACA). 
Some alteration was inevitable, whichever party came to power, because the ACA did nothing to improve the sustainability of the American healthcare system, and, in some ways, aggravated its unsustainability. The problem is one of costs. As Physicians for a National Health Program points out,
“Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($8,160 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates.” 
The answer as to why these results should obtain is clear. First, it is to be admitted that the existence of health insurance is a factor that raises the cost of healthcare. Medical providers are able to charge more for their services because of the deep pockets that health insurance companies provide. While the advance of medical technology certainly plays a role in rising healthcare costs, it cannot be denied that medical providers, being market participants in the United States no less than sellers of wheat or auto parts, charge what they can, and the existence of health insurance increases the amounts that they can charge and still expect to be actually paid.
At the same time, the fact that there are multiple health insurers creates a circumstance where medical care exists in a seller’s market. One must buy food, but one has a choice as to what food to buy, so there are competitive forces keeping the price of food down. Most people in the United States need transportation, but there are choices as to what kind of car to buy. And other items in the market, such as board games or lava lamps, are not necessities at all.
But when the need for medical care arises, there is no real consumer choice involved. Treatments are standardized, so one can expect the same treatment for his illness, regardless of the particular provider he engages with. Some doctors will have a better reputation than others, but the course of care will be the same. Indeed, if a doctor does not utilize the standard course of treatment, he will be liable for malpractice. The only real choice that is significant is to seek medical treatment or to avoid doing so, and, in many cases, avoiding medical treatment will be life-threatening. With market conditions like this, it is no wonder that the cost of healthcare tends to rise at a greater rate than overall inflation. 
From this we can see how the ACA would have a tendency to exacerbate rising medical costs. Because of subsidies, more people get health insurance coverage. But this adds to the number of potential customers for both healthcare providers and health insurers, and both will raise their prices accordingly.
Thus, a major argument for a single-payer healthcare system is that it reduces the potential purchasers of healthcare to one. With one buyer, healthcare providers are forced to sell to the one purchaser or not at all. The healthcare industry will begin to operate within a total buyer’s market, keeping a strong downward pressure on the cost of medical services.
Now it is not very likely that a Republican controlled Congress and White House will opt for a single-payer system. The Democrats haven’t exuded a great deal of enthusiasm for a single-payer system either, but we can forecast with a high level or confidence that the Republicans won’t be proposing such a plan. What is unclear at this point is what the ACA will be replaced with, if, indeed, it is replaced with anything.
But those of us who desire to follow Catholic teaching on the subject have clear guidance on what to support. In his encyclical Pacem in Terris, Pope John XXIII said this about the rights of humanity:
“But first We must speak of man’s rights. Man has the right to live. He has the right to bodily integrity and to the means necessary for the proper development of life, particularly food, clothing, shelter, medical care, rest, and, finally, the necessary social services. In consequence, he has the right to be looked after in the event of ill health; disability stemming from his work; widowhood; old age; enforced unemployment; or whenever through no fault of his own he is deprived of the means of livelihood.” (sec. 11) 
Medical care, then, is a human right according to the teachings of the Church. Moreover, governments have an obligation to ensure that right. As Pope John XXIII went on to say,
“The public administration must therefore give considerable care and thought to the question of social as well as economic progress, and to the development of essential services in keeping with the expansion of the productive system. Such services include road-building, transportation, communications, drinking-water, housing, medical care, ample facilities for the practice of religion, and aids to recreation.” (sec. 64)
While no particular method, such as single-payer, is prescribed by Catholic teaching, the right to medical care, and the obligation of government to see to it that such medical care is provided, is unambiguous. The ACA has failed in this, because, even though it has substantially increased the number of those covered by health insurance, it does not cover everybody. What’s more, it operates within an unsustainable healthcare model.
Now it’s the Republicans’ turn. Time will give certainty about whether they can do any better, or if making sure that everyone gets the healthcare he needs is even interesting to them.