The longest government shutdown in U.S. history is ending, but on dispiriting terms.

Having held out to protect affordable health insurance for millions of people, Senate Democrats splintered in response to the Republican leadership’s promise to hold a separate vote on that next month.

A fair compromise would have been to extend the expiring Obamacare subsidies for 60 days, in the same fashion as funding the rest of government. That would have covered the deadline to renew Obamacare marketplace policies.

But Democrats didn’t get that. There’s no guarantee how the December vote will come out in the Senate, or whether the House will honor that part of the deal. Faced with budget-busting loss of subsidies that will send the cost of premiums increasing by an average of 75% and much higher for many, at least 4.2 million Americans are likely to become uninsured in the new year.

Over time, some will die prematurely for lack of preventative care. Those struggling to keep their coverage will be paying a hidden premium because many healthy people are likely to drop their newly costly policies. Insurance economists call this a “death spiral.” It’s a sadly appropriate label.

For Democrats, the filibuster was a righteous cause. They held the moral high ground, but Republicans had the high hand. Their ace was President Trump, who’s so tone-deaf to the consequences of the shutdown that he held a Gatsby-themed Halloween party at Mar-a-Lago on the eve of food stamps lapsing for 42 million people.

Then he showed his indifference to suffering by threatening financial reprisals against the compassionate states that were trying to provide full food stamp benefits.

It is intolerable that we remain the only industrial nation where one’s entitlement to health care — and to life itself — depends so much on individual wealth or that of the shrinking number of companies that subsidize health insurance.

The Affordable Care Act (Obamacare) is a well-intentioned but imperfect answer to this national disgrace. As health care costs persistently rise and as Congress was unable to come up with anything better, Democrats managed to enact enhanced subsidies in 2021 — but only through 2025.

It would cost an estimated $60 billion to extend them for two more years. The ruling Republicans left that out of the budget bill they passed earlier, which required only a 51-vote majority, not the 60-vote threshold of a filibuster. The Democrats could do nothing but filibuster the actual appropriations.

Republicans have not given up on abolishing Obamacare. Instead, they talk about it less and use opportunities like Trump’s “big, beautiful” budget bill to dismember it, piece by piece.

A better solution is at hand. Medicare should be extended to everyone. Limiting it to people over 65 was another compromise between what’s right and what’s possible.

A single-payer universal plan should still be the ultimate goal of health reform. If the theme of the next two elections is affordability, there isn’t a more appropriate issue.

No matter what, this shutdown should be the last one. Those who prattle abut “running government like a business” would never run a company this way. No reputable business would survive by ordering its employees to work unpaid. No government should ask such sacrifice of its soldiers and civilian workers, or of citizens who go hungry when the government shuts down.

The Orlando Sentinel