The Affordable Care Act, otherwise known as Obamacare, is broken, both structurally and financially. Now the Republicans, who complained bitterly about being shut out by the ruling Democrats in the first round, are reciprocating. Lined up along the Potomac, the Democrats are using artillery, while the Republicans are relying on superior numbers. This is not difficult to understand at the Pentagon level, but at a time when most people have a historically low opinion of the Congress, it is an especially damaging and high-risk strategy.
The stakes in this war are quite high—we are talking about twenty percent of the economy, and I suspect over half of the dramas that play out in most families. Affordable, accessible and quality health care is not an inconsequential matter.
The Republicans won control of the House of Representatives in 2010—many believe on the voter’s distaste for Obamacare. They then staged dozens of repeal votes even though there was zero chance that President Obama would sign such a law. Plus, in the course of this charade, an alternative plan was not proposed. Unfortunately, voters often go along with politics of destruction regardless of which side is lobbing grenades.
Obamacare became law in March of 2010. The roll-out was marred by two overarching problems. The initial sign-up was a disaster, and the President promised voters that if they liked their health insurance, they could keep it and likewise their doctor. For many, this turned out not to be true.
If the plan had been a business product, it would have been quickly pulled from the market and re-tooled. Seven years later the re-tooling is taking place and, if new law results, it will be called Trumpcare.
President Trump, who made a big deal of his business acumen, must now deliver or be forever branded with a failure. A shard of light glinted briefly when Trump admitted that re-tooling the health care law was more complicated than he thought. He needs to revisit this fact and constantly remind himself that health care for many is a matter of life or death.
Obamacare underscored the difficulty in shifting risk. If everybody with a pre-existing illness is to be guaranteed affordable insurance an enormous payment will need to be made by either healthier insureds or taxpayers or both. But if risk shifting is the biggest issue, keep in mind that Obamacare was a two thousand page bill which now confronts lawmakers with a mish-mash of vested interests otherwise called alligators in the Washington swamp.
Restraint will not allow me to go much further into detail but let me make two radical suggestions.
First, and most importantly, Trump or members of the Republican majority who can actually lead should insist on a bi-partisan result. Trump, who tends to run toward controversy, should lead the effort as the legislative leaders will need cover. Since the end result will necessarily be right of center, the more moderate Democrats should be given prominent roles in the drafting of a new law. The Congress needs to own the law; Americans should not be whipsawed every voting cycle. Constant political wars have damaged representative government and undermine our health care industry.
Second, Washington needs to learn from Google and Apple. Both companies provide compelling products with intuitive consumer interfaces. The ease of use masks enormous underlying complication. A re-tooled health care program needs to do the same.
A final word to Trump. The likelihood of your namesake law being workable and relatively popular if crafted by hyper-partisans, under the constraints of budget reconciliation rules, is less than zero. A bi-partisan and fully public legislative process will at least give the public a sense that their representatives take their jobs seriously.