President Donald Trump pulled the trigger on Tuesday, following through on his promise to “let Obamacare fail” after Republican Senators filed to muster the votes to repeat their 2015 vote to repeal Obamacare entirely.
That does not mean Trump has given up on repealing and replacing Obamacare. Walking away from the table is, in this case, a negotiating tactic, through which Trump hopes to shock both Republicans and Democrats into compromise.
In his comments Tuesday, Trump was adamant that neither he nor his party will “own” Obamacare’s failure. And it is true that Democrats will suffer, as they continue to support a costly policy that is falling apart, and which they avoided every opportunity to fix when they had the chance. But Republicans in Congress will suffer more, and will certainly “own” their failure to honor the most important commitment they have made repeatedly to their voters.
Republicans have more to lose. If conservative voters remain frustrated with the party they voted into power, there is a good chance that Democrats will win the House back in 2018, if not the Senate as well. Trump will then be forced to compromise on Obamacare on Democrats’ terms: either preserving the core of the policy while patching its problems on an ad hoc basis; or moving to the single-payer, “Medicare for All” policy the left has long wanted.
Therefore Republican leaders will have to scramble to put a new compromise together. But it might have to be one that draws in Democratic votes, because the caucus clearly cannot bridge its own internal differences. One possible option is a plan that provides basic, catastrophic health insurance for all Americans and leaves the free market to provide supplemental policies to deal with everything else. It would cover more people, but cover fewer expenses.
Catastrophic care is the only area in which the two parties’ policy preferences overlap. Democrats — at least, some Democrats — would accept it, because it might open the door to expanding coverage for all. And while some conservatives might reject it, Ronald Reagan once embraced a similar proposal. “We can put a floor below which no American will be asked to live in degradation without erecting a ceiling over which no citizen can fly,” he said.
Another option is to create a process for negotiating that does what no effort at health care reform has ever done before — neither Hillarycare, nor Obamacare, nor the Trump effort thus far: namely, bring stakeholders to the table from outside of government. Doctors, patients, hospitals, insurance companies, pharmaceutical companies, research institutions — all ought to be sought for their input into reshaping the industry, in an open and public deliberation.
The reason Obamacare created such outrage long before it was ever implemented was the fact that President Barack Obama and the Democratic leadership rammed the legislation through Congress with no input or support from the opposition. They were prepared to challenge the boundaries of the Constitution, and of parliamentary procedure, to impose changes that few of them understood and none could defend. An open, inclusive process is long overdue.
President Trump could offer a plan of his own — incorporating some of the ideas above — but until Republicans can organize themselves in Congress, he has no reason to take that political risk.
And so it suffices for now, to let Obamacare fail, and for states, insurers, employers, patients to find their own way forward. But in the long run, that will cede health care to the left — permanently. The pressure is on Republican leaders, who are running out of time.
Joel B. Pollak is Senior Editor-at-Large at Breitbart News. He was named one of the “most influential” people in news media in 2016. He is the co-author of How Trump Won: The Inside Story of a Revolution, is available from Regnery. Follow him on Twitter at @joelpollak.