Time for Medicare for All

Forbes article: Click Here

Trump and the GOP establishment promised "something terrific."   They promised better, not cheaper.

Throughout the campaign Donald Trump condemned Obamacare for what it did not do for consumers.  The ACA was a disaster because it was too little.   He would replace it with something great.  

Trump has a problem actually fulfilling that promise, and the problem is his own team.  

There may well be a majority in Congress for a Medicare-for-all solution, but it would be a coalition of Democrats with a some Republicans.   Trump was elected as a Republican.  The government he formed made allies of conservatives, not liberal populists.  He mocks Democrats and clung to Republicans and that decision meant that his health care plan would require a Republican majority.  For now, at least, Trump is sticking with the team that got him elected, Republicans.

Republicans are divided.  Some want to emphasize government thrift, self reliance, and the judgement of the vicissitudes of good and bad luck.  The lucky and the provident keep what they have and the unlucky and improvident will not get to sponge off their neighbors.    

There is a big constituency for this kind of thinking, but not a majority.   Too many families have problems.  Too much life experience shows that sometimes the undeserving win and the virtuous get hurt.  But if there was to be a GOP majority in the House then this kind of thinking needed to be included in the mix, the unlucky and the poor don't get health care, or they only get emergency room crisis care.  Their misery is the price of being poor, the consequence of life choices and bad luck, or poor parents.  The theory is that government doesn't supply cars or exotic vacations for people and it has no responsibility to provide health care, either.

Not our brother's keeper

The result is that the bill that just passed is cheaper, and it provides worse coverage for fewer people.    The GOP votes weren't there without moving in that direction.

Theoretically, Trump could have astounded the public and formed a coalition with conservatives on social issues and the Supreme Court, but then formed a coalition with Democrats on a Trumpcare Medicare-for-all health care solution.  It would have fulfilled his campaign statements but it would have fractured his GOP support.

In the end, he chose to stick with an all-GOP government, so he went small:  less coverage, more people kicked off Medicaid, fewer protections for people with pre-existing conditions. The plan in March provided access to too many people to get the Freedom Caucus aboard; the April plan went too cheap and incomplete,  so moderates dropped off the other side.  The Upton amendment added back some money and then a bare majority of GOP members signed on.

The legislative battle was between less and cheaper versus better and more inclusive, but the public relations scramble is underway. Trump at the White House and moderate congressmen in their districts are telling voters that a cheaper program with less protection for people with pre-existing conditions, and many more of the working poor losing Medicaid, is actually better.   

Greg Walden, Chair of the Committee that wrote the bill, posted his two minute speech on the floor of the House onto Facebook.  He says nothing about it being cheaper, nothing about the tax cuts for prosperous taxpayers.  He isn't selling thrift.   He is selling quality.

Click here: Walden sells the bill as better and more inclusive.

He calls it "patient centered", he says it will protect people with pre-existing conditions, he says it provides states with flexibility, and he said he brought home the bacon to Oregon with $322 million extra dollars so fewer of his constituents will lose Medicaid than would normally be the case.

There will be tens of thousands who will lose coverage via the Oregon Health Plan but Walden can say this would be the choice of the state, not him, not his fault the Democrats in Oregon cannot find the money to replace what the federal government took away.

The big story here is not what is being said: obvious puffery and salesmanship. That is to be expected.  What is important is that they are trying to sell more and better.

Greg Walden's sales pitch in bright red Mountain-West rural district is a significant marker.  It may be time for Medicare for all.  Greg Walden is astute.  He knows what is happening politically.  It shows the center of political gravity has changed.   The country may well be ready for Medicare-for-all or some other all inclusive program.   Walden criticized a "one size fits all" program, thus touching base with the language of Republican voters who distrust government, but then speaks to the benefits coming from government.

Oops.  He wasn't supposed to say that aloud.

Donald Trump, in his meeting with the Australian prime minister accidentally blurted out a truth which must not be acknowledged, that the Australian single payer health system is superior to ours.  Oops.   People heard it.  Bernie Sanders praised it.  The White House is scrambling once again to backtrack and say Trump didn't really mean it.   Of course he mean it.    He didn't mean to get into trouble for saying it aloud but he meant it, just like he meant what he had been saying throughout his campaign.   He doesn't want a complicated program full of gaps and sob stories of people with untreated disease.  He wants something that was good, simple, and universal.

That is the center of political gravity.  The question is whether the legislative process will allow policies to flow in that direction.  Democrats may have an opportunity to think big.  Trump wants a great big tower of healthcare, bigger and better than Obamacare.  The proposal on the table is not it, but maybe something bigger and better is.