It’s a good thing the Trump administration is crafting a replacement for Obamacare, but it was a dereliction of responsibility for it to have taken so long.
President Trump enjoyed majorities of his own Republican Party in both the House and the Senate for two years, yet never produced an even halfway viable healthcare plan of his own. His lack of seriousness and initiative on that front was pathetic.
Now that his team apparently is serious about putting forth a plan, working with three conservative think tanks to build on prior, promising, independent efforts, the attempt will almost certainly be too little, too late. The odds against a Democrat-controlled House passing a Trump healthcare plan are about the same as the odds against Trump announcing he has consciously been an agent of Vladimir Putin all along.
Where was Trump all year in 2018 when former Sen. Rick Santorum, R-Pa., was coordinating a serious effort to revive healthcare reform? Yes, the Trump administration did a few good things nibbling around the edges of healthcare policy administratively, but it produced not a single legislative effort to revamp and improve the whole, cumbersome, misguided edifice of Obamacare.
With Republican majorities in both chambers of Congress, surely it was worth another attempt to produce a bill that could pass, and to sell the American public on it. If Obamacare is as bad as Trump says, and it is, the president was duty-bound to try to fix it while he had at least a fighting political chance to do so. Instead, he spent all of 2018 fulminating against an honorable special prosecutor who did him no wrong, and about a border wall he had little real hope of securing. His grade for actually working with Congress to legislate should be about a triple F-minus.
All of those criticisms notwithstanding, a president has a responsibility to try to improve public policy even if a highly recalcitrant opposing party controls part or all of Congress. That’s why, even though Trump is absurdly late to the table, he really is better late than never. First, unlikely as it is for his proposal to pass House Speaker Nancy Pelosi’s House, it’s better to try and fail to educate the public about real policy choices, than not to try at all.
If the topic at hand is as important as healthcare, then presidential leadership matters. And if political lightning strikes and Trump’s plan suddenly polls really well, there’s always the chance some Democrats facing tough re-election battles might want to sign on.
Moreover, while not even Trump seems to know exactly what provisions “his” plan will feature, the early reports about what his team is considering sound promising. In the Heritage Foundation, the Mercatus Center, and the Hoover Institute, Trump’s team has chosen serious and accomplished partners for reform. In using ideas from the Graham-Cassidy bill of 2017 and the Health Care Choices proposal that resulted from the Santorum-led effort, Trump’s team is starting with a solid policy base.
The latter proposal would send federal money and a great deal of policy choices back to the states to best take advantage of local conditions and on state-level policy innovation. It would dramatically expand consumer choice for securing health coverage best suited for individual conditions and for buying and for using health savings accounts.
If Trump had put energy behind such a proposal in 2018, he might actually have repealed and replaced Obamacare, and maybe saved Republican control of the House in the process. Now, he may just be tilting at windmills. Then again, some windmills deserve to be tilted at.