This week, says Kellyanne Conway, Donald Trump is going to decide whether his government, our government, will continue the subsidy payments to insurers under Obamacare. As I wrote recently, this can sabotage Obamacare by forcing said insurers to jack up rates on sick people.
Trump and the Republicans seem to think that if they make a bigger mess of health care, voters will continue to blame Barack Obama. Turn that around in your head for a minute. They’re in charge. The White House and Congress. They really think after two years of nothing but Republican control, with majorities to do whatever they please (provided they bend a couple Senate rules), that people will blame Obama?
Yes, they do. The Washington Post’s Dave Weigel tweeted an interesting quote along these lines from Rand Paul a few days ago:
You see what Paul is saying there. “It’s the fault of Obamacare.” That’s going to be the line.
It’ll work with their hard-shell voters. There’s a certain percentage of people for whom all you have to do is say “Obama” and their brains explode. But that’s not a very big percentage now, and it’ll be even smaller by November 2018 as memories fade (this is why it was smart for Obama not to interject himself in the health-care debate and why he should for the most part hang back until after the midterms; don’t make it at all about him, make it about Trump).
I try to limit my sports analogies to no more than four a year, but this is a good occasion for one. A football team fires its coach. The new coach comes in. You give him a pass in his first year; he’s assembling a staff, putting his system in place. By the second season, though, that patience starts to wear thin. Fans beginto expect some wins. By year three, they’re demanding wins. And if you don’t produce them, you sure as heck can’t go around blaming the old coach. People will laugh at you.
So the question is, what football year will November 2018 analogize to? It’ll be the end of Trump’s second calendar year, so the obvious thing is to say it’ll be his second season. But I’m not sure that’s right psychologically. A president’s first “season” is, I would argue, his first hundred days. That’s when the first report cards come in. We even tote up wins and losses. If that was Trump’s first season and we assume an NFL-like 16 games, he went about 2-14, being generous, the two being Neil Gorsuch and, uh…uh…
We’re in season two now. He’s on the job six months; theoretically he’s supposed to have learned something. He’s shaken up his staff. Shaken up is putting it awfully mildly. The only person he hasn’t fired is defensive coordinator Steve Bannon, in charge of a defense giving up about 45 points a game, but the hard-core fans love him so he’s untouchable (until he’s not). Season three will start next year. So I’d say we’ll be in season four by next November.
In season four, there are no excuses. The same psychology that governs the reactions of impatient fans will be at work here.
If Trump ends the subsidies, it won’t be just Democrats and do-gooder policy wonks quotes in news stories about how terrible it is. It’ll be the CEOs of insurance companies.
People will notice this. The narrative for the average person, assuming they never pass a bill, will be that Trump and the Republicans promised to repeal and replace Obamacare, they screwed that up even though they ran Congress, then Trump did this payments thing that I don’t completely understand but the people on my TV say it made things worse, and hey, he’s the president, not Obama.
Those who pay just a little more attention will know that what the Republicans are doing is crazy because what’s wrong with Obamacare is so easy to fix. Put most simply, all they really need to do for starters is extend and somewhat increase the subsidy payments, which aren’t that much money in federal budget terms, a few billion dollars a year, and find a way to require or cajole more healthy people to sign up for insurance. But they can’t do that of course for ideological reasons, because they hate the individual mandate, even though it was their idea in the first place (well, the Heritage Foundation’s, but close enough).
If Trump had a political brain, and if the GOP had a policy brain, here’s what they would do. They’d fix Obamacare. They’d say “you know, this individual mandate was a conservative idea originally, because it’s all about personal responsibility.” They’d embrace it and make it work, and then they’d say, “See? The Democrats gave you health care that was a mess. We straightened it out.” Lamar Alexander, who chairs the relevant Senate committee, is a reasonable man. He and Patty Murray, the ranking Democrat, could probably write a bill in a day.
But they can’t do that because Trump doesn’t have a political brain and the party’s policy brain has completely atrophied. There are some serious conservative policy intellectuals and a few serious lawmakers, but the party as a whole doesn’t think anymore. It just operates on caveman reflex. Obama did it—bad! Government—evil! Giving people health coverage—they don’t deserve it!
Speaking of deserving it, they’re going to deserve what’s coming but good. They will own health care—and it’ll own them.