Monday, March 27, 2017

Governing in the Age of Obama-Trump.

The failure of the health care repeal-replace-fix-alter-redo whatchamacallit has a thousand mothers. But as Democrats celebrate, and the new announces that the first 100 is the worst 100 and that Trump is over and.. what, we can go off and celebrate, let me bring you back to reality.
Nothing in politics is ever as it seems, and the media, for some odd reason, never look father than their nose.  Let's assess where we are:
1. Obamacare lives on. As it adds trillions to the debt and family budgets with higher premium costs and limited reduction on medical expenses, there is little doubt that unless altered, and altered pretty radically, there will be very few private insurance companies left to provide insurance. What will be left is the massive increase in medicaid eligible (where the vast majority of newly insured are going) and a continuing problem for anyone who needs to buy insurance for themselves and their  employees.
2. If that happens, then the entire program will be reexamined.  You cannot enforce a "penalty-tax" if the person has no option to buy anything.  The Court will strike down the rule, and the enforcement fails.
3. Remember, the bill failed not because it wasn't being luxuriant enough for  the Freedom Caucus Republicans but because it wasnt fiscally conservative nor market oriented enough.  You think the next option up will be less conservative?
4. So, where we are is on the path to a collapse of the medical insurance option under the bill, and a massive realignment of insurance premiums for not merely those affected now, but for every employer and every employee in the US.  When unions and professors and companies and Universities see 20-40% annual increases in that part of their budget, something has to give. Higher tuition? More cost share for employees? Higher deductible, co-pays, less coverage? Shifts to more employee controlled (and paid for) coverages?
5. And the Republicans will still not understand. A week after the ACA passed, I wrote  a short piece proposing this solution: Pass a bill that required the agencies and companies affected by ACA to enforce it "exactly as written." Remember all of the exemptions, changes, delays that occured in the first  two years? Nope, you wrote it, voted for it, that's your baby.  The entire bill would have collapsed, or the people affected by the bill as written, would not have had their hurt delayed.

And the collapse of President Trump is not (sorry to be such a wet blanket) imminent. Our government, our system, is designed to provide means for strong presidents to succeed, and means for weak presidents not to fail. So, until President Trump figures out that he is only in charge of people and ideas that move with him, supported by the people, and that those must get through a system full of opposition, and that you cannot make a deal with each member like you could with a business partner because some of them, many of them do not want your deal and will not suffer from its failure.

Let's see how much and how fast President Trump can learn this new lesson, this new paradigm.
The art of the deal in government is compromise, but on your terms, and deftly, often labored over months, years, until the exact right moment when you see the light and push and idea into the void.
Who ever thought you could sum it up in 17 words?

1 comment:

Jo Sue said...

I am commenting just to see if it records. The one I did on your last post did not, nor did any of the ones before that one.
Thanks for continuing the blog. We need your insights and perspective in this what is for many of us, trying times!