Even though it is almost surely misattributed to her, Marie Antoinette has long been remembered by the words “Let them eat cake” — her supposed response to being informed that the French peasantry were starving and had no bread to eat. We can only hope that the American voter long remembers that 239 Republicans (no Democrat crossed party lines) voted to fully repeal the Affordable Care Act (ACA) without any viable alternative in place for the millions of Americans covered by it. Nor indeed, any viable alternative for those still uninsured (22 percent of the population was uninsured before ACA, 15 percent continues to be uninsured) in a nation that stubbornly insists on touting private market solutions despite the evident corporate profiteering.

A New York Times article from 2013 shows the costs of medical procedures in the United States are appallingly inflated. An angiogram in the United States, for example averages $914, compared to $35 in Canada. Hip replacement surgery will cost an American an average of $40,364, while in Spain it costs $7,731. A prescription for Lipitor will run $124 here, while in New Zealand it’ll cost $6. In India, the cost of the drugs needed to treat Hepatitis C is $1,800, while in the United States the cost for the same course of treatment, the same drugs, is $84,000. There’s obviously a repugnant and immoral profit margin built in to those costs.It’s no surprise that 62 percent of personal bankruptcies in the United States are prompted by medical expenses, even though 75 percent of those who declare bankruptcy have private health insurance (according to Dr. Oliver Fein, a proponent of universal coverage, based on data from 2009).

But ... let them eat cake, right?

Despite our fine speeches about being a nation of equal opportunity and equal treatment under law, our provision of healthcare before ACA was out-and-out discriminatory — with insurance, insurability, and means to pay, the primary determining factors in quality of, access to, and ultimately receipt of care. 

ACA is, without question, a still-imperfect solution — while there are some subsidies, particularly in states that opted in to the Medicaid expansion, coverage is neither universal nor free — but it did go a good way in ensuring that those who have never been able to get health insurance could at least have the hope to do so without devoting their entire household income to pay for it.The Republicans in Congress have challenged ACA more than 50 times already, because ... let them eat cake.

According to the Henry J. Kaiser Family Foundation, “In 2013, 61 percent of uninsured adults said the main reason they were uninsured was because the cost was too high .... Many people do not have access to coverage through a job, and gaps in eligibility for public coverage in the past have left many without an affordable option.”

Among the uninsured, 44 percent are ages 18 to 34; 33 percent are Latino, and a full 11 percent say that even with ACA in place, health insurance is still too expensive. According to a Transamerica Center for Health Studies report from late 2014, ”even without the cost of paying premiums, the uninsured population says they’re struggling with health costs. Only 22 percent said they were able to afford their routine health expenses, such as doctor’s visits and medications.”  

We are one of the very few nations in “the developed world” that relies on private insurance rather than offering universal, free healthcare to its citizens. The arguments against “free-and-universal” are usually cost and quality of care. But our government spent more on our privately administered and very spotty healthcare — before ACA — than countries with free, universal plans: about $8,233 per person in 2010, which is twice as much as France, Great Britain and Sweden spent.

The quality of care argument is only valid if you actually can get care ... and for 41 million uninsured Americans, as well as those 10 million or so who are currently covered thanks to ACA, that is no more certain than bread was for the famine-stricken French masses in Marie Antoinette’s time.

Maybe the Republicans who voted to repeal ACA (three Republicans voted no) should remember how poorly the “let them eat cake” sentiment played out for Marie Antoinette (and her husband King Louis XVI). Even if the Republican-led Congress doesn’t manage to successfully repeal ACA (Obama has said he will veto the bill), the choice to look out for the well-being of corporations (the median profit earned by drug companies in 2012 was $71.1 billion) at the expense of ordinary Americans (whose median household income was $51,371 in 2012) will be noted. 

Especially come the 2016 presidential elections. How about we start referring to that as “the guillotine?”