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Donald Trump’s health-care bill is already in a death spiral

Donald Trump
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Donald Trump

Presidents campaign in poetry and govern in prose, as the saying goes. In Donald Trump's case, his pitch was hardly poetic. But it was easy to grasp. Mr Trump would make America great again through sheer force of will.

This included abolishing Obamacare and replacing it with a healthcare system that would be cheaper, better and would cover every American. It turns out that in practice "Trumpcare" will do nearly the opposite. To judge by this badly drafted bill, Mr Trump is governing in gobbledegook. Either the legislation will fail in Congress, which would be a political disaster for Mr Trump, or it will pass, which would be a catastrophe.

The irony is that Mr Trump already knows this. Having spent a lifetime naming things after himself, he has made it clear that he does not want his name associated with this healthcare bill. Anything but Trumpcare.

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Yet that is the right name for the bill. It is a personification of Mr Trump's brand of politics. The bill's most important feature is that it abolishes a law that is popularly named after his predecessor, Barack Obama. Opposition to Obamacare's actual contents plays little part in the desire to replace it.

Indeed, Mr Obama's Affordable Care Act borrowed heavily from a 1990s plan created by the rightwing Heritage Foundation as a market-based alternative to "Hillarycare", the failed bill devised by then first lady, Hillary Clinton. Likewise, Obamacare was slightly to the right of the bill that Mitt Romney, a former Republican presidential candidate, enacted as governor of Massachusetts.

Since Obamacare drew on conservative thought, it is no wonder Republicans have had difficulty coming up with a viable alternative. Yet having described Obamacare as a jobs-killing, socialist takeover of the US economy for the past seven years, they had to try. Their bluff has been called.

The bill's second Trumpian element is its upwardly redistributive effects. It would cut taxes on the top 2 per cent of Americans by $885bn over the next decade and cut spending on the poorest Americans by almost exactly the same amount. As a result, there would be 24m fewer Americans with health insurance by 2026 according to the non-partisan Congressional Budget Office. A disproportionate share of those losing their insurance would be older, white Americans who voted Trump. This too is a classic Trumpian bait and switch. He promised something radically different to what he is delivering. The elites get a tax cut. The poor will lose protection.

"The irony is that Mr Trump already knows this. Having spent a lifetime naming things after himself, he has made it clear that he does not want his name associated with this healthcare bill. Anything but Trumpcare."


Then there is the bill's thoughtlessness. Much like the "Muslim ban" on issuing visas to six Islamic countries, or the U-turns on China, Nato and other issues, Mr Trump clearly had no grasp of the substance. The policy was Mr Trump himself. Details would be worked out later. Now we know the details, the absence of thinking is glaring. Trumpcare has little to do with healthcare and everything to do with fiscal redistribution. The bill is so badly drawn up that nearly every US healthcare lobby, including those representing doctors, insurers, retired people and hospitals, is opposed to it. It takes skill for a Republican president to unite business against his plans. Chief executives know the cost of throwing millions of people off insurance will be borne by taxpayers and employers.

To be sure, there are serious problems with Obamacare. Mr Obama should have included tort reform in the bill, which would have capped medical liability for doctors. He should have imposed a stiffer penalty on those who refuse to take out insurance, to make sure healthier Americans broadened the risk pool and lowered premiums.

Likewise, he should have created a nationwide exchange so that people could shop across state borders. But improving the system is not the aim of Mr Trump's bill. When his supporters realise they are being left by the wayside, his poll numbers will suffer. Mr Trump's approval rating is already below 40 per cent.

Mr Obama devoted most of his first 18 months in office to healthcare reform. Many thought he was wasting his capital. Yet the bill brought 20m into the system and took America a step closer to universal coverage.

It also slowed the rate of US healthcare inflation. The backlash cost him Democratic control of Congress in his first midterm election. The irony is that abolishing Obamacare could cost Mr Trump Republican control of Congress next year.Mr Trump now faces one of two disasters. The least bad is that Republicans reject the bill. It would be in their interests to do so. Far from making America great again, Trumpcare would exacerbate its worst feature.

Mr Trump now faces one of two disasters. The least bad is that Republicans reject the bill. It would be in their interests to do so. Far from making America great again, Trumpcare would exacerbate its worst feature.