The whole concept of government getting involved in any aspect of health care goes against the Republican orthodoxy of free market control.

Lost in the Republicans’ months-long effort – first in the U.S. House and now in the Senate –  to “repeal and replace” the Affordable Care Act, or Obamacare as it is popularly known, is the ultimately reality that “replace” can never happen, at least not unless a majority of elected Republicans shift their basic thinking on health care.

The GOP has always been the party of limited government, determined to let the market decide what works and what doesn’t for the American people. So any effort to inject the government – even a little bit – into the process goes against their basic ideology.

Obamacare’s individual mandate, the part of the law that makes everyone buy insurance, has been the focal point of Republican opposition from the beginning. You can’t force people to buy something they don’t want or don’t think they need, the thinking goes. Doing so is unconstitutional.

Democrats, meanwhile, consider basic health care coverage to be a human right, covered in the preamble of the U.S. Constitution where it mentions promoting the general welfare of the populace. ("… insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity …").

That argument gets a boost, of sorts, from longstanding laws that have required hospitals to treat patients coming to their emergency rooms regardless of their ability to pay.

But the money to pay for that treatment has to come from somewhere, and traditionally it has been those who can pay who have been forced to dish out for higher costs. Over the years, rising health care costs and insurance companies that were charging the most they could while offering the least possible in return put the squeeze on a lot of families.

Those who encountered catastrophic health issues often quickly burned through their savings and were put in dire financial situations. Families had to decide whether to provide medical care for a loved one, or keep their home. In a May 4 article, Time noted that personal bankruptcies declined 50 percent between 2010 and 2016.

Obamacare insuring 20 million more Americans, and the laws governing coverage – such as not denying people coverage for preexisting conditions and putting an end to lifetime coverage caps – helped reduce the number of bankruptcies, the magazine wrote.

But the money to pay for that had to come from somewhere. Obamacare did result in some tax increases for the rich, but it also relied on the individual mandate. The Republican effort to repeal and replace Obamacare rests squarely on repealing the mandate and, to a lesser extent, rolling back those tax increases. Obamacare also increased the number of people who could get coverage through Medicaid.

To repeal Obamacare is simple. Just negate the law. The trouble with that is 20 to 25 million people will lose health insurance. The rest of us will likely pay more as insurance companies return to the days of skimpier policies and higher costs for the sick and elderly. Repealing the law would negate the tax increases and would take away the individual mandate, thus eliminating the revenue source that, in theory anyway, was supposed to fund this whole thing.

Replacing Obamacare, however, isn’t as simple.

Republicans say premiums will come down if we allow a free market system.

But the problem with that is we had a free market system, and costs were going up by double-digit percentages for years.

Families were going bankrupt. People who could not afford coverage suffered. So it is a safe bet that returning to those days won’t produce the desired results.

Plus, there is the matter of the millions upon millions of people who have gotten coverage under Obamacare who would lose it if the rug was yanked out from under them. Republicans have no plan for keeping health care costs down, or for ensuring that people who need coverage can get it without being bankrupted.

Add in the fact that there are two factions within the GOP -- the side that believes in survival of the fittest and believes Obamacare should be repealed no matter the cost in human suffering, and the side that thinks government does have some obligation, however limited, to help people in need – and you can see the massive hurdles that Republicans have to overcome.

At the end of the day, either Republicans will pass a repeal bill and take us back to the days of more limited coverage and even higher costs, or they will pass some form of replacement bill that is nothing more than a watered down version of what we currently have.

They could, of course, work to improve the current law, but to do that they would have to work with Democrats, so that isn’t likely to happen.

The bottom line, however, remains that the whole concept of repeal and replace is flawed. They can repeal the current law, or they can replace it with something similar, using many of the same components already in place, but they can’t do both.

With things stalled in the Senate now, it will be interesting to see what path the party takes.

Jim Lee is editor for GateHouse Media Delaware. Email him at