Donald Trump understood the average Republican voter well enough to disregard the party’s tired orthodoxies and still win the presidency. He figured out that most Republicans could care less about shredding entitlements and adhering blindly to Milton Friedman’s soulless economic agenda, as long as he was bashing immigrants. To this day, Trump still won’t fulfill Paul Ryan’s Ayn Randian fever dream of gutting social security and Medicare.
But he does promise to do Ryan’s bidding and repeal Obamacare, a move that is all but guaranteed, if successful, to make a lot more people who voted for him sick. This probably doesn’t worry Trump too much in the short term, since senior citizens in the West Virginian hollows and dead factory towns of Ohio can’t afford dues at Mar-a-Lago anyway. Republicans in Congress, unused to and uninterested in governing, want to tear up Barack Obama’s signature achievement as quickly as possible because that will fill the emptiness of a nihilist campaign vow.
Few rational people think Ryan’s American Health Care Act is anything but a disaster-in-waiting. Swapping a mandate for ungenerous tax credits and eventually killing the Medicaid expansion while preserving the most expensive and popular aspects of Obamacare (not discriminating against people with pre-existing conditions and letting everyone under 26 remain on their parents’ health plans), the AHCA will strip coverage from 24 million people by 2026, according to estimates from the Congressional Budget Office.
Were Trump a cannier tactician – or just a very different man – he would try to co-opt a beleaguered Democrat party by actually bolstering Obamacare, triangulating to save his party’s historic majority. Imagine if Trump’s team seriously considered the flaws of the ACA and tore a page from the playbook of the most populist Democrats to address them.
We already know there’s an overlap between the people who voted for Obama and Bernie Sanders and those who eventually chose Trump. The desperate working class of this country, white and black and brown alike, are seeking answers as automation and globalization threatens to sideline more and more laborers forever. Trump can gratify his own galactic ego and do some good by actually saving them.
As it stands, Trump’s obsession with pushing Ryan’s catastrophic bill is the best gift an otherwise pathetic Democratic party could envision. Republicans control every branch of government, two-thirds of governorships and far more state legislatures than Democrats, a level of dominance unseen in more than a half century. But the sooner any version of the AHCA becomes law – no sure thing as Senate Republicans and moderates in the House balk – the more furious the backlash against the party of Trump will be.
Democrats are giddy that Republicans are on the verge of owning a healthcare catastrophe. Smarter Republicans are catching on. Arkansas senator Tom Cotton, usually a reliable ideologue, recently said voting for Ryan’s bill would put the Republicans’ formidable House majority at risk.
As unlikely as this scenario would be, the Trump White House could heed Cotton’s warnings and change course. Support increasing subsidies for the lower- and middle-class people who truly find Obamacare unaffordable. Expand Medicaid coverage. Try to entice younger, healthier people to buy insurance or just force them. Discover the unreliable New York liberal lurking somewhere in that tanned hulk and back a cheap public option to compete with private insurers, driving prices down.
Rebrand the effort. Obamacare can become Trumpcare, except Trumpcare will actually work for everyone. For all his business failures, Trump does know something about marketing and reinvention. What’s the best way to stick it to his bete noire, Obama, and punish Democrats for good? Make Obamacare (Trumpcare) better.
It’s easy to snicker about a Republican president doing this. But Trump owes his party little, and its orthodoxies even less. He is a cult of personality, a ringmaster who can command his legions of followers to the end of the Earth, no matter what he says or does. The working-class white Americans and midwestern swing voters who put him in power won’t punish him for making government more generous and welcoming.
Trump can choose the courageous and practical path of attempting to usher in an era of affordable, universal healthcare coverage to a nation in profound need of both. Or he can punish the American people and his own party with Ryan’s dreadful legislation.
Just don’t expect him to choose wisely.