Pinkerton: Making American Healthcare Great Again, Part Two

Second of a series.

In Part One of this series, published on April 6, we considered the fluctuation in Trump administration healthcare policy over the previous couple of weeks. Those fluctuations led President Trump to tweet on April 3 that he would wait until after the 2020 elections to seek a congressional vote on his healthcare plan.

At the time, most observers took that to mean that the White House would wait until after November 2020 to release its plan. A plan, that is, as distinct from something to actually be voted on.

After all, the Democrats in control of the House aren’t interested in working with Trump, and the Republicans who run the Senate aren’t into healthcare changes, either. In fact, according to Axios, Senate Majority Leader Mitch McConnell recalled telling Trump in late March: 

Just so we don’t have any misunderstandings, we are not going to vote on health care before 2020. Just so we’re clear.  And I’m not going to put together a working group. If you want a plan, it’s going to have to be yours. But we’re not going to vote on it.

Recalling the Senate’s debacle of the “repeal and replace” effort in 2017, one might empathize with McConnell’s reluctance to touch healthcare. In the Kentuckian’s calculation, with 21 Republican Senate seats on the line next year, what’s the point of releasing a healthcare plan if you don’t intend to have a vote on it?  After all, if the plan is so popular that everyone loves it, why wait two years for a vote?  Or, on the other hand, if the plan is not popular, why put it out there and let people shoot at it for two years, making Senate Republicans, in the meantime, the collateral damage?  

Yet these days, there’s always a twist in the tale. On April 7, acting White House chief of staff Mick Mulvaney told Fox News Sunday that the administration expects to release its new healthcare plan—a proposed replacement for Obamacare—soon: “I do think you’ll see a plan here fairly shortly.”  

In the meantime, we already have some clues as to at least some possible features of the plan. For instance, Trump has long said that he wants to protect those with preexisting medical conditions. That’s understandable, since support for such protection, according to the Kaiser Family Foundation (KFF), stands at 75 percent. 

To be sure, some critics have sniped that Trump policies would have the effect of undercutting such protection, but as of now, at least, the danger seems remote. Moreover, the President himself is emphatic on protection. On April 3, a Trump tweet included the pledge, “Republicans will always support pre-existing conditions!” 

We might pause to consider what a pledge to protect those with preexisting conditions means for any health insurance plan: It means that it has to be big and ambitious. We’ll get to some of the reasons why ambition is necessary in a future installment, but for now, we might consider the fate of the last president who had a big and ambitious healthcare plan.

That last president, of course, was Trump’s predecessor, Barack Obama. If the healthcare issue is due for a revival, as the 45th president is indicating, then it’s worth recalling—and seeking to learn from—some of the pitfalls that befell the 44th president.

When then-Sen. Obama announced his presidential candidacy on February 10, 2007, he was bold and declarative: “We will have universal healthcare in America by the end of the next president’s first term.” In that year, 2007, support for national health insurance was at a high: according to Gallup, 69 percent.

National health insurance, of course, had been a staple of Democrat politics since the 1940s, and yet it had never been achieved, although Democrats had made partial gains along the way—most notably, the enactment of Medicare and Medicaid in 1965. 

Yet in his campaign, Obama put forth a new and novel argument: His national health plan, massive expansion of Uncle Sam’s role that it was, would actually save money. How so? Well, that was never exactly clear, beyond the usual promises of better management and greater efficiency.

Still, Obama was so sure of himself that he added specificity: His plan, he pledged, would “bring down premiums by $2,500 for the typical family.”  This was at a time when the average cost of health insurance for a family of four was a little over $12,000. 

So we can see: In tossing around that figure of $2,500 in savings, Obama was promising a reduction in overall cost of more than a fifth. For those willing to take Obama at his word, that was a great offer.

By contrast, Obama’s Republican opponent that year, John McCain, was offering a far more modest healthcare program, consisting mostly of tax credits, with no guarantee of coverage. As observers at the time pointed out, “aims to cover everyone” was the more popular position. And that was one reason that Obama won the ’08 election in a landslide.

Of course, as we all remember, once he was in the White House in 2009, Obama, as well as the Democrats who ruled Congress with wide majorities, had great difficulty in actually enacting Obamacare.

In particular, critics focused on Obama’s pledge to reduce healthcare costs; they asked what that would mean for ordinary Americans. Could the feds really cut costs by more than a fifth per family, just by weeding out the proverbial waste, fraud, and abuse? Or would the savings be achieved in darker ways?  

In fact, one scary answer came from Team Obama itself. In July 2009, Peter Singer, a leading academic supporter of the Obama health crusade—by now dubbed “Obamacare”— published a piece in the New York Times under the blunt headline, “Why We Must Ration Health Care.” Thus the “r” word, rationing, was injected into the debate, big time.  

So now Republican critics were free to offer their own interpretation of what Democrat rationing could mean. The following month, in a landmark Facebook post, Sarah Palin let it rip: 

The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

Of all the punchy language Palin used, the phrase “death panel” was the punchiest.

By now, support for national health insurance was falling fast. According to that same Gallup series, support fell to 54 percent in 2009, and to 47 percent in 2010. Indeed, in ’10, opposition reached 50 percent, meaning that Obamacare was under water by three points—a stunning turnabout.

Yet the Democrats were nothing if not determined; the legislation, formally known as the Patient Protection and Affordable Care Act, slogged to enactment—and Obama signed the bill into law on March 23, 2010.

In the meantime, on the right, the Tea Party was in full force. And who can forget the 2010 midterm elections, when Republicans won 63 seats in the House, flipping control of the chamber and making substantial gains everywhere else?

By then, KFF was running monthly tracking polls on the specific popularity of the Affordable Care Act, as opposed to the hazier concept of national health insurance. And KFF’s findings weren’t pretty for Obamacare; in January 2011, 50 percent of Americans opposed it, and just 41 percent supported it—that is, a nine-point deficit. Indeed, later that year, Obamacare was as much as 17 points in the hole.

Still, the news wasn’t all bad for Obama; he was, after all, reelected comfortably in 2012. And yet, of course, in the 2014 midterms, the Democrats suffered another shellacking, losing the Senate as well.

Then came the 2016 elections, in which not only did Trump win, but so did the Republicans in both the House and the Senate.

Yet in 2017, something interesting happened: According to KFF, support for the Affordable Care Act started rising. That is, Obamacare went from under water to above water; as of March 2019, support for the program stood at 50 percent, while opposition was just 41 percent. In other words, the program that was once as much as 17 points below the waterline is now nine points above it.

So what’s going on? One explanation is that the popular features of Obamacare have starting kicking in. A second, bleaker, explanation is that Trump is so polarizing that if he’s against Obamacare, more Americans will rally in favor of it.

And speaking of hardcore Obamacare supporters, Obama himself is still around, making his voice heard. In an April 6 speech, the former president looked back and allowed that his signature program hadn’t done everything he wanted, and yet even so, he was proud to have “establish[ed] the principle that everybody gets health care.”

We might pause over those words, established the principle that everybody gets health care.

Is Obama correct in his sunny statement? Does that sunniness include guaranteed coverage of those with preexisting conditions? And if so, since Trump says that he agrees on such protection, what might that mean for the forthcoming Trump plan?

We’ll take up those questions in the next installment.

Next: Some Bets on Trumpcare.