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Here is my
imagined scenario of how Donald Trump’s healthcare policy would go. With the defection of McCain, Corker and
Flake, as well as the firm opposition of Collins and Murkowski, no plan to shut
down Obamacare can muster even a majority in the Senate, so Trump continues his
policy of sabotage. It succeeds. Every increase in premiums, every reduction
in options, every county that loses all coverage he proclaims victory and
announces as proof that Obamacare is failing.
Failure begets failure, reports of failure in one county discourage
people in other counties, which cause insurers to flee the exchanges, which
discourage sign-ups, and soon the whole system comes crashing down.
Trump
declares victory. He announces that
Obamacare has finally failed and the people are freed from its oppression. He calls a party of Congressional Republicans
and Republican donors to celebrate. They
dance for joy. They throw confetti. They shoot off fireworks. All over the country, Trump supporters join
in. They proclaim freedom of this
monstrous oppression. They dance in the
streets for joy. They throw confetti. They shoot off fireworks. They rejoice in their liberation from this
monstrosity.
Then reality
hits home. People all over the country
who lost their health insurance when the exchanges collapsed can’t find it
anywhere else. Many have serious medical
problems. Without subsidies, people in
rural areas and older people, no matter how healthy, find that their premiums
skyrocket. If Trump is also successful in rolling back
Medicaid enrollment, many rural hospitals may shut down as economically
unviable. Trump supporters are
disproportionately affected. Perhaps healthy young men, especially in urban areas, and possibly healthy young women
with no plans to have a baby any time soon benefit. But if Congress is unable to repeal the
Obamacare regulations, the collapse of the exchanges may bring down the
individual insurance market outside the exchanges as well.
Trump
supporters ask where is the much better plan that Republicans assured us they
had ready in their pocket. Where is the
plan that will deliver awesome health coverage at a fraction of the cost? And then they will be shocked to learn what
everyone else knew anyhow. Republicans
don’t have a plan. Or, at most, their
plan is to repeal the Obamacare regulations requiring an essential health
benefit and forbidding discrimination based on pre-existing conditions, or
allowing insurers to compete across state lines. This will make coverage cheap for anyone who
doesn’t need it, but prohibitive for anyone with actual medical problems. And the Republican leadership overall just
won’t see this as a problem. They will
have gotten rid of that evil monstrosity, Obamacare, and nothing further is
needed. Freed of the malign tyranny of the government,
the free market will come up with an optimal solution any day now (checks
watch). And if that ultimately means
people with pre-existing conditions can’t get coverage and are left to die,
well if that is what the free market wants, it must be optimal.
And then
things get interesting. Some Trump
supporters continue to support him.
These include ones on Medicare and ones who get coverage through their
employers, which is, after all, a majority of the population. Others lose their health insurance and blame
it on Obama and don’t blame Republicans at all for failing to do anything about
it. But others lose their health
insurance or have family members or friends who lose their insurance or see
their rural hospitals shut down and respond with anger and betrayal.
Trump will be enraged. He will
lock himself in the bathroom and tweet out petulant, self-pitying tweets.
He will denounce all reports of people losing coverage as “FAKE
NEWS!” He will blame it on “FAILED
OBAMACARE” and a Republican Congress that can’t pass decent legislation. He will say that it isn’t his fault, how was
he supposed to know that deliberately crashing that system that provides
healthcare to 10 million people would cause problems. And he will be utterly unable to imagine that
it isn’t all about him. And in this
case, since he was the one who deliberately crashed the exchanges, he will have
a point.
I should add
that this is a fantasy. Although this is
the logical outcome of the course Donald Trump is on, I don’t think it is what
will actually happen. Why not? Because the exchanges won’t be here today and
gone tomorrow. Before the exchanges fail
altogether, they will start to seriously malfunction. Premiums will skyrocket. (That is already beginning). Entire counties will find themselves without
insurers, particularly in rural areas where the most Trump supporters
reside. Some rural hospitals will
fail. And all of this will get ample
coverage. Of course, Trump will denounce
this as “FAKE NEWS” and many of his supporters will agree. (Fox, Breitbart, etc. either won’t cover it
or will blame it all on the failings of Obamacare). But that will be sort of like telling the
people of Puerto Rico not to believe the stories about hardship in their
country. Residents of pro-Trump rural
counties losing their coverage and possibly seeing their hospitals close will
be aware of what is happening. They may
blame it on innate failing of Obamacare rather than deliberate sabotage by
Trump, but in the end they will want someone to do something about it. The pressure on Congress to do something will
grow.
And therein
will lie the problem. Republicans will
be ideologically opposed to doing anything about it and, even if forced to act
by political reality, won’t have any realistic plan to improve the
situation. Democrats will have plenty of
plans, but will be in the minority and unable to pass any of them. If they retake one house of Congress, they
will be unable pass it in the other.
Even if they take both, they won’t be able to get any plan past a
Republican filibuster.* And even if
they somehow manage to pass something by budget reconciliation or get enough
Republican defectors, Republican donors will probably convince Trump to veto it
and there is no way Democrats will have the votes to override.
In short,
Republicans have learned that it is easier to destroy than to build. They are currently hard at work on it,
destroying Obamacare with possibly major collateral damage to the insurance
system, wrecking regulatory agencies, causing possibly irreversible damage to
the environment, and destroying the State Department and, with it, our ability
to engage in diplomacy. And this is best
seen as a warning to voters and Democratic politicians alike – do not elect
Democrats and, if you do, don’t even think of doing anything once in
power. Because Republicans WILL destroy
whatever Democrats may achieve, and they don’t care about the damage they cause
along the way.
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