Who Knew Health Care Was Hard?

President Donald Trump was speaking to a meeting of the National Governors Association about health care reform a couple of weeks ago, and he offered up yet another one of those occasional quotes of his that cause us slap to our foreheads. “I have to tell you, it’s an unbelievably complex subject,” he said. “Nobody knew that health care could be so complicated.”
Every sentient American already knew that health care is darned tricky, and certainly each of those governors hearing the speech were especially well aware of it, so it’s a sobering thought that pretty much the only person in the country who thought it was easy is the president. Even the minimal amount of regulation that a free-market purist would agree to for the ever-evolving and increasingly high-tech medical sector that comprises a full sixth of the nation’s $17.4 trillion economy is bound to be tricky, managing every aspect of it is beyond the ambitions of even the most arrogant Democrats, and any compromise you might find somewhere in between is bound to be exponentially more complicated. The policy questions are daunting enough, but as Trump as surely figured out by now, the politics involved are even more convoluted.
Trump and the Republicans running the two chambers Congress rolled out the first of three promised phases of their plan to repeal and replace the current Obamacare system earlier this week, and if they thought that getting it passed into law was going to be easy they should now be wised up. There are still enough Democrats left in Congress to make trouble for for any changes in Obamacare, although the law is unpopular enough throughout the districts and states that it’s largely responsible for a Republican White House and an electoral victory for a Republican president, and there are still enough pre-Trump sorts of Republicans left in both chambers who won’t stand for any aspect of Obamacare, even those several provisions that poll extremely well with the general public, and what with politics making strange bedfellows they can cause all sorts of complications together.
Unless you’ve been too busy with your reality television show or branding negotiations to have been paying attention, for the past seven years or so the repeal and replacement of the hated Obamacare has been the metaphorical Moby Dick to the Republican’s Captain Ahab. Not one single Republican, even though squishy ones that you still find up way up northeast, voted for the damn thing, everyone last one of them has cast meaningless votes for its repeals on a regular basis ever since. From the most staid conservative publications to the most shrieking talk radio shows the entirety of the party was opposed to Obamacare, which was forced on a resistant public with some procedural legerdemain and a variety of lies about lowered costs and keeping your plan and your doctor that were eventually exposed, and conferred unprecedented powers on the federal government, and had monogamous couples paying for sexually-transmitted disease coverage and Catholic nuns paying for contraception and otherwise permanently altered its social contract with citizens, and generally offended every old-fashion Republican principle. As the false promises about lower costs and freedom of choice were exposed the Republican majorities in Congress grew, and with a Republican president who wouldn’t have gotten his party’s nomination without an unequivocal promise to repeal and replace Obamacare it should have been easily accomplished.
Politics is always complicated, though, and Trump’s apparent belief that it’s actually all quite simple adds another layer of complexity. The parts of Obamacare that allow young people to remain on their parents’ plan until age 26 and let people sign up for insurance at the usual rate after a pre-existing condition have been discovered poll well with the public, the subsidies that are being provided to a reported 20 million or so people are even more more popular with that reported 20 million or so people, and among them are some folks who will have tear-jerking stories to tell on the nightly news, and at this point it’s hard to tell how the unpopular Trump will fare against the unpopular Obamacare. All the Republicans are taking care not to call the new policies Trumpcare, even Trump, who usually loves to put his name on things, because at the moment both Trump and Obamacare seem equally unpopular.
As the pre-Trump sorts of Republicans, we were hoping for that most minimal sort of regulation no matter how complicated that might prove. If the insurance wants to sell policies that allow include children to any old age we’d be happy to let them, and expect that many would find it profitable to do so, but we wouldn’t force them do so no matter what the polls have to say about it. The preexisting conditions thing about Obamacare comes with all those heartbreaking stories, but you could just as easily interview people who couldn’t get flood insurance after their house was underwater, and no matter how heartbreaking it just doesn’t make economic sense. We have some red-in-tooth-and-claw solutions to the whole matter of rising health care costs, too, but we acknowledge they won’t poll well, and admit that the ever-changing high-tech world of medical marvels makes it very complicated.
Interstate health insurance plans and no mandated coverage of unnecessary producers and much of what else we were hoping for wasn’t included in the latest proposal but is promised to come in phases two and three of the great Republican health care reform roll-out, and for now we’ll take their word for it. Still, we can’t help wondering why they’re dishing it out like that. Something in phase one might make sense if it were done in conjunction with something in phase two or three, but not otherwise, these things being very interrelated, and the uncertainty of what’s to come only complicates matters further. Coming up with something better than the undeniably disastrous Obamacare system should have been a relatively simple matter, but of course Trump complicated matters by promising something “wonderful,” which of course is a whole lot harder to achieve.
Trump was all over the place on the issue during his improbably victorious campaign, wowing the Republicans with the usual repeal and replace rhetoric, but also promising the broader public some spectacular but unspecified plan where everyone would be covered and the government would pay for it and the costs would go down and quality of care would go up, and he really should have expected that would prove complicated. He’s already abandoned a campaign position in favor of that stupid individual mandate that requires poor people to pay a penalty for not having insurance, but endorsed a plan that would allow insurance companies to charge a 30 percent fee on people whose insurance have lapsed, and he’s no longer talking about the government paying to insure everybody, but he has abandoned enough longstanding Republican positions about the proper role of free markets and individual liberty and meddling bureaucracies in the nation’s health care to lose some Republican support. On the other hand he’s still retreating from the Democrats’ positions on those very vital questions, and won’t likely get any support from a single one of them.
We’re hopeful that at the end of all this complicated fuss that’s going to consume the next several months we’ll wind up with something that’s at least better than that dreadful Obamacare, but we don’t expect that it’s going to wind up being something as wonderful as what was promised. Obamacare wasn’t altogether bad, otherwise its repeal and replacement wouldn’t be so thorny, but it’s dreadfulness was made all the more apparent in contrast to the sales pitch, and what’s likely to known as Trumpcare surely won’t be altogether good, so its promises should be made accordingly. That’s not the Trump style, of course, and some painful but necessary procedures will probably be left out of the care, and we expect the fuss over it will outlast us all.
One of the few old-fashioned Republicans who has somehow enthusiastically embraced this newfangled Trumpist party is Arkansas Sen. Tom Cotton, who has been surprisingly outspoken in his opposition to what’s thus-far been rolled out. He “tweeted” that the Democrats were too hasty in passing that darned Obamacare when they enjoyed a Democratic White House and majorities in both chambers of Congress, and urged that his own party not repeat the mistake. We like Cotton’s old-fashioned Republicanism, and despite our disappointment with his enthusiasm for Trump’s newfangled party we think his advice to slow down and get it right is sound. The Republicans should take at least enough time to hear all three phases of what they’re doing, gauge just how free-market the party can get away given the current political climate, do what’s doable, and be satisfied if the results are somewhat better than Obamacare even if it so wonderful that nobody dies.

— Bud Norman

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