A key Trump friend and ally is urging the president to dump Paul Ryan's Affordable Health Care Act and embrace something that sounds sort of like a lightweight version of a single-payer health care system. Christopher Ruddy, CEO of the conservative Newsmax brand, isn't normally considered a major thought leader on policy issues, but he is a longtime friend of Trump's, and counts as one of a relatively small number of conservative players who have closer ties to Trump than to congressional Republican leaders.
And he is warning loud and clear that Trump "could inherit the bad political baggage of both Obamacare and the House Republicans" if he insists on going along with Ryan's version of repealing and replacing Obamacare.
Instead, Ruddy puts forward the rather radical notion that Trump should attempt to live up to his campaign promises on health care rather than signing on to legislation that betrays them all. To do it, he encourages Trump to ditch his effort to court the Freedom Caucus and instead come up with a bipartisan plan that accepts a large government role in providing insurance coverage.
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In an op-ed published Tuesday, Ruddy argues that Trump "should be sticking to his own gut on healthcare reform." He did this during the campaign, which helped him "win Democratic states like Wisconsin, Michigan and Pennsylvania."
And he offers the following seven-point "game plan for Trump to regain the initiative":
- Ditch the Freedom Caucus and the handful of Senate Republicans who want a complete repeal of Obamacare. They don't agree with universal coverage and will never be placated.
- Find a few parts of Ryancare II [i.e., the AHCA; Ryancare I refers to Paul Ryan's longstanding desire to privatize Medicare] that can win passage in the House and Senate with either GOP support or bipartisan support. Declare victory.
- Rekindle the bipartisanship in Congress that President Obama destroyed. Impanel a bipartisan committee to report back by year's end with a feasible plan to fix Obamacare.
- Reject the phony private health insurance market as the panacea. Look to an upgraded Medicaid system to become the country's blanket insurer for the uninsured.
- Tie Medicaid funding to states with the requirement that each pass legislation to allow for a truly nationwide health care market.
- Get Democrats to agree to modest tort reform to help lower medical costs.
- While bolstering Medicare and improving Medicaid, get Republicans and Democrats to back the long-term fix of health savings accounts. This allows individuals to fund their own health care and even profit from it.
As a pure political strategy, the key elements here are probably the first three points. A commission probably won't lead to any major changes, but that's okay. According to the Congressional Budget Office, the Affordable Care Act exchanges will probably stabilize in the next year or two even if nothing changes. Trump can do nothing and fix it.
But steps 4 through 7 do suggest a route to a possible future vision of American health care.
The standard progressive prescription for American health insurance has, for decades, been that a Medicare-like program should cover all Americans. That's what Harry Truman proposed, but interest group politics eventually led Medicare to be defined down to a seniors-only program in order to secure passage in the early 1960s.
But while Medicare is the gold standard of government-provided health insurance for the United States, there is also the cheaper Medicaid for low-income families. Medicaid offers stingier reimbursement rates to health care providers, which makes it less costly to the government. But it also makes Medicaid patients much less desirable to doctors and other providers, many of whom don't accept Medicaid patients. Yet despite the program's limitations, the evidence is overwhelming that people who receive Medicaid like it.
Indeed, surveys tend to show that people who obtained Obamacare coverage via Medicaid are happier with their coverage than those who get subsidized private insurance on the new marketplaces.
One could thus imagine "Medicaid for all" as a lower-cost alternative to "Medicare for all." More affluent people would probably find Medicaid coverage to be excessively restrictive for their taste, in which case they would probably seek to obtain supplemental insurance — a practice that's common in France and some other countries with national health care systems. But the private insurance system would exist as a layer on top of a basic blanket of security that guarantees health care fundamentals for everyone. You could certain tack health savings accounts (Ruddy's point 7) on top of this as well.
Now, needless to say, embracing this idea would be a huge break with the ideological orthodoxy of the Republican Party. But Trump really did campaign on a promise of universal coverage. And as he told CBS's Scott Pelley back during the primary, "the government's gonna pay for it."
The GOP establishment's bet since Inauguration Day has been that Trump didn't really mean it when he said that. And so far, their bet has paid off. Ruddy is suggesting that maybe Trump should stick to the ideas that let him beat the establishment and win the election. It's an idea that's so crazy it just might work.