Whatever Ryan says about it, it is a stepping stone to Single Payer. If it is not a full repeal with no replace then repeals of other government interference in and manipulation of insurance and medicine it is all headed to Single payer which is what almost all of the politicians want and the Chamber of Commerce wants and even Trump has suggested that SS might be the fair answer. Single Payer does make political campaigns easier in that the medical system becomes the single issue that all elections will be run on. Pols will strive to promise to tweak it this way and that way to get certain voting groups a little ahead in line or a little better treatment as the system loses medical talent. The effect on the economy will be place a lead weight atop it and it can never get going into boom again. What we call recession now will be touted as good times.
We are pretty much doomed to Single Payer after Congress and the Bureaucracy fiddles and tweaks for a couple of years and most people in the economic middle get cut out altogether. The rich can get their medical care from a private and discreet system that sucks up whatever medical talent remains. The poor and the middle will not be allowed alternatives except offshore and passport control may well wall that off, too.
The only real options are entirely free market or single payer; nothing else works.
Every compromise we’ve had since WW2 has just given us the worst aspects of both cold hearted ‘let the folks die who can’t afford care’ free market model AND the meddlesome socialistic model. With few of the benefits of either