So much for repealing and replacing Obamacare. The Graham-Cassidy Senate bill is on life support. Members of the Senate death panel have made their decision, leaving their patient on palliative care to spend the last few days of life on heavy pain meds but without lifesaving treatments.

Death is scheduled for the end of September when time runs out on the reconciliation rules which allow the Senate to pass legislation with only 51 votes, rather than the usual 60 votes needed to overcome a filibuster.

Graham-Cassidy is far from perfect, but as the old saying goes, perfect is the enemy of the good. Perfect would be a complete repeal of Obamacare, as Senators McCain and Murkowski once promised. Perfect might also be a totally libertarian approach to healthcare, no government mandates, only the laws of the free market, as Senator Rand Paul desires.

Purists want a total repeal of Obamacare. Good luck with that. Congress only had the will for repeal when Obama was in the White House, ready to veto whatever fantasy the GOP concocted. Now that we have a Republican president, the veto threat no longer exists, and Congress lost its appetite for repeal.

Entitlements and bureaucracies are never repealed. Especially once there are beneficiaries, and despite the harm they inflict on the country. Purists also talk of abolishing the IRS and closing bloated agencies like the Departments of Education and Energy, but that won’t happen either.

Unless a few Democrats join with the not quite fifty Republicans, Graham-Cassidy won’t even come up for a vote. That’s too bad as this may be the last option for at least trimming back the choking weeds of Obamacare. Another year of double-digit premium increases, 50 to 75 percent in McCain’s home state of Arizona.

Insurance premiums costing more than mortgage payments for many families. Not to mention narrowing networks of physicians and hospitals. And out-of-pocket costs keeping people away from the doctor. What good is insurance if you can’t afford to purchase or use it?

McCain wants a bipartisan approach, his proverbial reaching across the aisle. Where’s his plan? What legislation has he proposed? What Democrat senators has he convinced, via “reaching across the aisle” to support any recent GOP plans?

If the current once-in-a-generation Republican Congressional majorities cannot get anything done, will President Trump start looking “across the aisle” to his new pals Chuck and Nancy? As he did with the debt ceiling. The Democrats sure have a plan. It’s called single payer. Bernie Sanders’ Medicare For All bill which has the support of 17 Democrat senators, a third of their caucus.

Obamacare is clearly unsustainable. Fewer insurance options, increasing costs, fewer treatment options, all pointing to collapse. A third of counties have only one Obamacare insurer. Obamacare is a star collapsing into a black hole, perhaps exactly as it was designed. What’s left if the Republicans have no alternative? Only Bernie’s plan as the last man standing, ready to be implemented out of desperation.

Perhaps that was the grand plan. Ask then-Senator Obama who said single payer is the goal, but “we can’t get there immediately.” Bernie’s plan is ready to fill the void that Republicans can’t seem to fill.

If so, then why not a two-tiered system, as I have described previously? A government-run system providing basic bare bones insurance for everyone and a parallel, free-market insurance system, free of government mandates, for those who so choose.

It provides something for both sides of the political aisle, rescues the current failing system, and is pragmatic enough that President Trump could get behind it. Given the failings of the majority party controlling Congress, it may the best we can hope for. Certainly better than losing Congress to the Democrats due to Republican inaction and incompetence. Allowing them to enact a one-tiered system, Bernie’s plan, all government all the time.

Brian C. Joondeph is an ophthalmologist and can be reached on Twitter @retinaldoctor. This article originally appeared in the Daily Caller.

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