Why the Republican Health Care plan is what it is and the future of health care in the US

There are legitimate issues with the "Obamacare" version in place today. The individual mandate is meant to prevent insurance companies from going south due to having to insure people who would not be insurable in the system they were built upon. And there are subsidies atop that to do the same thing, and to make health care less expensive for the extreme poor. Essentially we're supporting a middle man that should be unnecessary if you go hard left or we're subsidizing and removing freedoms by funding insurance companies and mandating participation if you go far right. The system is a patch to an existing system that cannot be remodeled easily or fluidly. So many people who lost out in this ruleset have a strong interest in seeing it fall and they don't have it without good reason.

That's the context.

The Republican party is pretty pragmatic most of the time regardless of what you think of them as people. They know a true repeal would be damaging in the short term (the election range) because anything tumultuous is. It's a change. Even if they did manage to make a change for the better it would be disliked for a few years until the dust settled. And they might do it badly or have bad actors involved and pass something disastrous. And that backlash may lead to their being in the Democrat seat in a few years time. Politics is a pendulum. People tend to dislike any one party having all the branches and they're going to see a swing back out of absolute power soon. Adding fuel is unwise for the party, ignoring all the outside context of the people this impacts. It's a risk.

So they're focusing on a short term goal. Signal to the base "we're doing it" and try to keep the status quo to avoid losses. All while priming things for tax cuts in the future due to the THEORETICAL future savings granted by this version that will never materialize.

People have been worrying about the proposed cuts and restructuring. But most of the significant things people would consider bad don't come until much later dates. And that means they won't come. They will be modified at a later date by the Democrats or at least stalled out. Because eventually the pendulum will swing again and they know their time in power is as numbered as any other parties in their position. Americans dislike handing any one group the keys.

The real scheme at hand:

If this bill passes they'll be set up to point to the savings that will come from the future dismantling/restructuring of medicaid and other systems as justification for tax cuts (possibly under reconciliation depending on how the game is played
https://en.wikipedia.org/wiki/Reconciliation_(United_States_Congress) ). They're squeezing money from the future to pay for the present. This isn't about a restructuring of healthcare. It's about taxes.

To anyone worrying about medicaid or Obamacare please refocus on the real threat in all of this.

The individual mandate is dying. It going away is in some ways a good thing. If it were part of a whole new system that could be a boon. But in terms of this system it may well bankrupt it. Especially as their patch to that (6 month waiting period to re-enroll if you go without coverage for 60 some odd days) is ripe for abuse and will be totally dependent on enforcement mechanisms that aren't well laid out. Future legislation to provide exemptions and special dispensation is also a risk that is very real on this one.

Whatever system you prefer, a system that isn't sustainable makes us all lose. That's where this is heading.