We’re told that the failure to repeal Obamacare is a big black eye for the Republicans. Maybe so, but it’s actually a good thing for the Trump administration. That’s because the proposed repeal-and-replace gambit would have been a political disaster. Sixty percent of the American public wants a universal healthcare safety net, in which no one can be denied help for pre-existing conditions. All of the recently proposed GOP plans leave Americans vulnerable to the loss of their savings through the costs of treating catastrophic illness. Should such a plan pass, Republicans would suffer huge losses in the House in 2018, and the possible loss of the Senate and White House in 2020.
The issue is not going away. On one side, Bernie Sanders will propose a socialistic, “Medicare-for-all” proposal next month. On the other, Graham, Cassidy, and Heller are leading the GOP charge to repeal Obamacare while punting the problem to the states. Now is the time for Trump to make clear that he is not merely the leader of the GOP. He must act as a Presidential Third Force to lead us out of the current impasse.
Trump gave the Congressional GOP every opportunity to fix the Obamacare mess on their own terms, and they failed utterly. The Sanders socialized medicine would double governmental health spending, forcing tax rates and deficits to unsustainable levels. Trump is now free to triangulate with a realist and populist solution, one that protects all Americans from financial ruin due to medical catastrophe while protecting our country from fiscal meltdown.
Trump is thus in an enviable position: he can offer coverage to all Americans, co-opting the Democrats’ most important issue. We are already more than halfway there: federal benefits currently cover 49 percent of all medical costs. The number of people with catastrophic pre-existing conditions is quite small — about 400,000. Obamacare was designed to make the relatively small number of who are paying their own way in health insurance exchanges (about 8 million) to bear the whole cost of supporting the 400,000 truly needy. That was unreasonable and unworkable: those suffering catastrophic costs ought to be supported from the general revenue.
Currently, in order to qualify for Medicaid, an American family must first exhaust their savings. A simple change could turn Medicaid into a true safety net: cover 100 percent of any American’s medical costs for essential services, once those expenses have consumed some fixed level (say 10 percent) of one’s share of household annual income, regardless of the size of one’s savings. This benefit would be paid for by eliminating all tax benefits for medical insurance (which is by far our largest tax expenditure) and by imposing maximum prices on medical providers for covered benefits. We can keep Trumpcare costs within any budgeted limit that we choose, by simply limiting what is covered and how much will be paid for each covered treatment.
Such a reform would create a two-tier system. We would have a perfectly free market for ordinary medical care, a libertarian utopia in which third parties would be eliminated, and the patient would simply pay his or her doctor directly. For catastrophic illnesses, there would be a simple benefit that would protect a family’s savings from devastation. Americans could purchase medical insurance if they wish to be covered for illnesses that fall below the catastrophic boundary, or if they want coverage for non-essential treatment. All would be free to use the doctors of their own choice.
Under our current system, we spend more of our GNP on government health benefits than does any country other than Norway. Trumpcare could save both the government hundreds of billions of dollars by eliminating the insurance middlemen, by holding down inflation through the bargaining power of the federal government, and by limiting payments to essential services. The support of social conservatives could be secured by excluding abortion.
Obamacare was cobbled together to satisfy a host of special interests. A bold stroke that promotes instead the real interests of working Americans would transform the political correlation of forces.
Even if establishment Republicans and Democrats were to block Trumpcare, Trump and his allies would be well positioned to make gains in both the primaries and general elections of 2018. All who voted against Trumpcare, both Republicans and Democrats, would have to explain why they opposed a medical safety net of a kind the American people want. After taking the issue to the American people in 2018, running against a Do-Nothing Congress as Harry Truman did in 1948, President Trump could then fix the health care mess in 2019, once and for all.
Rob Koons is a professor of philosophy specializing in logic, metaphysics, philosophical theology, and political thought. He is the author and editor of six books, including "The Atlas of Reality: A Comprehensive Guide to Metaphysics" (with Tim Pickavance, Wiley-Blackwell, 2017). He has been active in conservative circles, both nationally and in Texas, including the Intercollegiate Studies Institute, the National Association of Scholars, the Texas Public Policy Foundation, the Philadelphia Society, and the Austin Institute for the Study of Family and Culture. To read more of his reports — Click Here Now.
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