Before the Heritage Foundation health care plan, first passed into law as Romneycare in Massachusetts, and then as the Affordable Care Act (aka Obamacare), the insurance industry could directly exclude, or by charging sky-high premiums effectively exclude, people with pre-existing illnesses from health care coverage.

There are 129 million such people in the country. Most are covered under employer-based group plans, but if they left their jobs, voluntarily or involuntarily, they were left to fend for themselves.

So, to address this major problem in health care coverage, without being handed the horrific numbers of those thrown off insurance by all of the Republican monstrosities, any alternative must begin with a plan for pre-existing conditions.

That is what the Heritage Foundation/Romneycare/Obamacare plan did. It regulated the insurance industry by outlawing excluding people with pre-existing illness. And, it made it financially sound by adopting the principle of personal responsibility in the form of the individual mandate designed and heralded by the Heritage Foundation.

There is no plan for pre-existing conditions that works that does not include everyone. The currently healthy help lower the premiums for the currently sick. And, when they become ill, they can get affordable coverage. (Steve Scalise [R-LA] is benefiting from that deal right now.) Thats what insurance isa fact that seems to get under the skin of the radical Right.

If one does not accept that, then one must oppose all insurance: auto, theft, life, etc. If everyone were ill or died or had auto accidents or had their homes burgled only when they bought insurance, any system would crumble. No insurer would insure. Insurers depend on most premium payers NOT needing to make claims at a given time.

There are three ways of including everyone. One is to mandate that everyone purchase insurance. Another is to enact taxes to pay for it. The last is a combination of the two.

Conservatives used to insist on individual responsibility. That is why the Heritage Foundation plan invented the individual mandate. Indeed, they crowed about that crowning moral principle. But, since not everyone can afford the premiums, some subsidies are mixed in so that everyone can pay something, but not be priced out.

So, if one, as one must, begin with fixing the exclusion of patients with pre-existing conditionsall 129 million potentiallythen Republicans who are opposed to taxes, opposed to their own concept of the mandate, and opposed to subsidies, could never, ever, possibly design a plan that worked without throwing millions off care.

And that is exactly what happened.

Thus, the entire enterprise was doomed to failure unless Republicans relented on their opposition to one or another way to get everyone inside the system.

Do you not think that, if there were a non-mandate/non-tax/non-subsidy solution, that was, as the president promised, beautiful, very cheap and very easy to enact, that the Republicans would have floated it to the CBO years ago as the Heritage Foundation/Obamacare alternative?

The outcome of the Republican repeal/replace was always clear. It would either fail to pass, or the replacement (including nothing at all) would devastate tens of millions of families.

All of which means this: Republicans took Congress in 2010 and have maintained control based upon a monstrous set of lies, that they could repeal the Affordable Care Act and design a solution that prohibited insurers from excluding from coverage people with pre-existing conditions, and get rid of the mandate and taxes.

Not once in these last seven years did Republicans fashion a full replace bill that they sent to the CBO for scoring. That should have told us all something. The yapparazzi (aka pundits), paid to analyze at least one level below the rhetoric, should have hammered this.

For seven years, Republicans escaped systematic scrutiny with the response we are working on it. The feckless Democrats never held them accountable.

Donald Trump asserts that he knows more about health care than anyone, and that his plan will cover everyone with beautiful health care at a fraction of the cost.

Lets see it. Lets demand to see it.