After the failure to repeal and replace Obamacare, President Trump met the press in the Oval Office. It was an unusual meeting. The President seemed almost mellow. He said: “We learned a lot.”
And the tweet that immediately followed was similarly un-Trumpian. He said the nation should not worry, that in time something better than Obamacare or the failed Obamacare replacement (Ryancare?), would emerge.
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So, what was learned? What should be the takeaway for the country, Speaker Paul Ryan, and the President?
A reasonable answer came from our own governor, John Kasich, one week ago. He voiced what many Americans are feeling right now: To get something done, you have to reach across the aisle to the other party. You have to find a consensus on a few points. And you work up from the possible rather than down from the grandiose.
What would that mean in reforming and repairing Obamacare?
Well, first get off the repeal kick and stop running against Barack Obama. That might be hard for this President, but it is the first necessary step toward a working relationship with some Democrats. Liz Warren and Bernie Sanders are never going to work with the Trump Administration. But Democrats in swing states will — if the offer is good politics for them.
Making Obamacare better is good politics.
To do that, the next step is obvious: Repair begins with the points of wide agreement:
● We keep the ban on disqualifying pre-existing conditions for insurance.
● We keep children eligible to stay on their parents’ insurance until the age of 26.
● We keep the expansion of Medicaid. This was the sticking point for moderates such as Mr. Kasich and Sen. Rob Portman, because otherwise we’d be throwing millions of Ohioans under the bus. It’s a good bet that the President has figured out that the victims would be his voters — “forgotten” men and women in Middle America. The moderates were right, the Freedom Caucus was wrong.
These are the pillars of Obamacare that people like and want to keep.
Moreover, the basic entitlement to health insurance must stay. We don’t roll back entitlements in American politics.
As ProMedica CEO Randy Oostra says, we cannot progress on health care and health insurance if we approach both as welfare programs. We must think in terms of public good and public health.
Then we add some Republican reforms that are no brainers:
● Let people buy health insurance across state lines.
● Let small businesses create their own insurance alliances, or exchanges, also across state lines.
● Create incentives for users to consider costs, and shop around for care they need.
● Don’t force consumers to buy more insurance than what they want or need.
● Expand tax-free medical savings accounts.
The missing link, and the center of a Grand Bargain on health insurance, is cost control. Two ideas: First, a federal price control board for drug manufacturers. Second, designating Medicare as the catastrophic insurer for all Americans — once your medical bills reach 10 percent of your net worth, after exhausting your MSA, you go into the Medicare system. Those are just two ideas. There will be others as good, or better.
The point is that if we focus on repair, not repeal, there is consensus around many fundamental points.
It took from Franklin Roosevelt to Bill Clinton to perfect and refine Social Security. Mostly the consolidation happened in the 1950s and 1960s when there was still a “vital center” to American politics. The greatest partnership of that period was between Dwight Eisenhower, president from 1953 to 1961 and Lyndon Johnson, Senate minority leader from 1953 to 1955 and majority leader from 1955 to 1961. Those two gentlemen knew how to find common ground and get things done.
They are an example and an inspiration for today.
First Published April 2, 2017, 4:00 a.m.
