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Trump better learn from failure of Obamacare replacement: James Miller

By James Miller
Posted 4/5/17

You win some, you lose some, and then you really lose some.Donald Trump, the Manhattan real estate maven who escaped bankruptcy unscathed multiple times and improbably robbed the political elite of …

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Trump better learn from failure of Obamacare replacement: James Miller


You win some, you lose some, and then you really lose some.
Donald Trump, the Manhattan real estate maven who escaped bankruptcy unscathed multiple times and improbably robbed the political elite of their biggest electoral prize, just experienced the first real loss of his presidency.
And it wasn’t a small change loss like the Trump Taj Mahal going belly-up on the Jersey Shore. Trump lost “big league” on his first major legislative gamble — cajoling the House of Representatives into passing an Obamacare replacement bill.
Crafted by Speaker Paul Ryan, the proposed law was so toxic to members that it failed to get a vote on the House floor.
“It is much easier to write a good play than to make a good law,” said George Bernard Shaw.
For Ryan and Co., it apparently was far easier to construct a farce dramedy rather than draft a workable bill.
The hardline conservative sect of the House Freedom Caucus demanded the bill, known as the American Health Care Act, go further in dismantling Obamacare. Moderate Republicans thought it went too far in stripping people of health insurance.
In hindsight, a law that fails to please principled objectors and squishy back-benchers is probably sound. The Affordable Care Act was never going to be fully swept away like a dust bunny hiding underneath the couch. Piecemeal reform was necessary, and invariably some parts of Obamacare would stick around.
So Ryan went to work in crafting a suitable substitute for Obamacare’s Byzantine swath of codes and regulations. What emerged was a product different in name but similar in complexity.
Conservatives fumed. The left cackled with giddy anticipation. President Trump gave tepid support.
Trump, whose focus is aesthetics, wanted a quick win. Wonkery is not the president’s forte, so he relied on Ryan to shepherd the bill through Congress. That mistake proved fatal.
Whatever its name — Ryancare, Trumpcare, nowherecare — the GOP’s replacement plan had little to do with health insurance and everything to do with tax cuts. No Republican could confidently make the case that the AHCA would make insurance more affordable. To make matters worse, the tacked-on tax relief was paid for by cuts to Medicaid funding — a blatant wealth transfer from the poor to the rich.
Not a good look for a president whose campaign was fueled by resentment for rich, liberal elites.
For Trump’s core supporters — low-income white provincials — this was the sellout of a century. A handful of GOP senators and governors representing Rust Belt states warned that Ryan’s Obamacare replacement would hurt many of the same people who put Trump in the White House. “The folks who Hillary Clinton called the ‘deplorables’ are actually those who want better coverage, who we’d be hurting if we don’t change this bill,” Sen. Bill Cassidy of Louisiana told The New York Times.
After spending seven-plus years campaigning full-speed-ahead on putting the kibosh on Barack Obama’s biggest achievement, Republicans were bound to hit an impenetrable wall: Americans, by and large, prefer government intervention to make health insurance more affordable. When polled, the public think portions of Obamacare — the ban on denying coverage for pre-existing conditions, young adults staying on their parents’ plan until they turn 26 — are nifty and too crucial to scrap.
It was always going to be an uphill battle to reform Obamacare. Had Republicans offered a plan that would actually cut costs over time, it would have been an easy win. But Republicans, being Republicans, were able to turn a tough-but-conquerable marathon race into a swim across the English Channel with weights strapped to each arm.
Paul Ryan’s posturing as a gymrat who devours Laffer Curve white papers for leisure was not enough to go the distance and deliver a bill to the Senate.
With the debacle behind him, Trump has pledged to move on from health care and focus on tax reform. The many problems of Obamacare will remain with us. Its most costly and most popular provision, the ban on insurance denial for pre-existing conditions, will ensure that costs keep rising. That’s because guaranteed coverage defeats the point of insurance, which is a guard against the future.
By forcing insurance companies to accept those who are already ill, the cost is transferred to other policy holders. It’s the equivalent of making insurers accept someone who wants car insurance right after an accident. There is nothing to insure; just immediate payment.
As a society, we have determined that is a worthy tradeoff. Poll after poll demonstrates as much. The rub is that the GOP’s free-market ideology can’t be reconciled with the popular view that health care should be highly regulated and controlled.
The inability, or plain dismissal, to accept that fact will doom any Republican effort to repeal and replace Obamacare.
The silver lining is the Republican Party is no longer led by a laissez-faire zealot. Donald Trump never pledged fealty to the Gospel of Reagan. His dragging the GOP, kicking and screaming, in a more worker-friendly direction has the potential to reform health care in a way that isn’t a sop to the insurance industry or an entitlement that induces dependency.
The president needs to go back to relying on what won the election for him: His nationalist instincts. There is talk in Washington that Trump may reach out to Democrats rather than rely on the ultra-conservative Freedom Caucus to pass pieces of his populist agenda. That’s a great start to recovering from this early quarter fumble.
Should Trump revisit health care, he should keep two things in mind. A replacement plan should be focused on aiding those who lack the resources for insurance, while doing something —anything! — about the ever-rising cost of care.
Paul Ryan has proved a failure at accomplishing that very thing. The time for new thinking, and new blood, is now.
James E. Miller, a native of Middletown, works as a digital marketer in Northern Virginia.