It was astounding last night to watch the TV talking heads drool over Donald Trump’s soft-sell performance. The bar for this guy is set so low that when he doesn’t swing from the trees, he’s somehow “presidential.” The bar is so low that a centipede could vault it.
Wow. He managed to go a full hour without tweeting or bellowing. His congressional-podium voice was soooo sooooothing that somehow we’re supposed to forget his insinuating claim, made hours earlier, that Jews have been bomb-threatening their own community centers and desecrating their own cemeteries. (Oh, absolutely. Jews think it’s a great idea to use babies in rolling cribs as political pawns. It’s right up there with being great negotiators.) I also loved it when he said, “The time for trivial fights is behind us” — a line that will likely be rendered obsolete the next time he tweets.
So much for his soft-sell stylistics. I’m more interested in parsing the substance of what he said. Or, to be more precise, the glaring lack thereof.
A president is supposed to lead. Congress expects a president to lead, especially a president of the same party affiliation. But what Trump delivered last night, in his joint address, was a heaping plate of platitudes, a repurposed campaign pitch served up at lowered temperature, with budgetary math that wouldn’t pass muster at Trump University.
Best case in point: His vaporous remarks about repealing and replacing Obamacare.
This is supposed to be the first big project of the new Republican president and his Republican Congress. But even after seven years of raging against Obamacare, Republicans still have no replacement plan — and no clue how to craft one that will please the party base and mollify the 20 million Americans who have gained coverage thanks to health reform. As for Trump, he talked big on the trail about repealing and replacing Obamacare “immediately,” and, as recently as six weeks ago, he claimed he was putting “the final strokes” on a credible replacement plan.
But naturally, that was just another con from the Don.
Remember the campaign, when he serenaded the naifs with promises of “something terrific” that would “take care of everyone”? That if he were elected, Obamacare will vanish and “amazing things will happen”? Truth is, he has nothing.
In the speech last night, he said: “I am also calling on this Congress to repeal and replace Obamacare with reforms that expand choice, increase access, lower costs, and at the same time, provide better healthcare.” But he never said how that could be accomplished. That’s no surprise, given the fact that Trump has zero experience with policy complexities and the incremental grind of government. It’s easy to promise goodies, but governing is all about how those goodies can feasibly be delivered.
Trump has no idea. How does he expand choice, increase access, lower health costs and provide better health care — while also satisfying conservative demands for lower federal taxes and reduced health care spending? Under Obamacare, lower-income Americans (including many blue-collar Trumpkins) get federal subsidies to help them buy coverage; if those subsidies are killed, how would these people be able to buy equivalent coverage? Trump offered no clue.
He also said last night: “We should ensure that Americans with pre-existing conditions have access to coverage.” But if Obamacare is repealed, how would those Americans get guaranteed coverage?
They’re covered now, under Obamacare, because other provisions of the law make it possible. The law requires – via the “individual mandate” – that virtually everyone, especially the young and the healthy, buy insurance; their premiums offset the high costs of covering those with pre-existing conditions. Republicans, with still no help from Trump, have yet to figure out how they’d cover the neediest folks if they kill all the mandates and Obamacare taxes that make the coverage workable.
Trump also said last night: “We should give our great state governors the resources and flexibility they need with Medicaid to make sure no one is left out.” Frankly, I have no idea what that means. A lot of Republican governors love the fact that Obamacare has expanded Medicaid; federal dollars have flooded into their states, to help give poor people health coverage. But the draft of a House Republican replacement plan would slash the Medicaid expansion, and the governors oppose that. It seemed that Trump was siding with the governors against Paul Ryan and the conservative House members who hate the Medicaid expansion; on the other hand, maybe “flexibility” is code for giving the governors block grants instead of Medicaid (thus covering fewer people), but who the heck knows. He probably doesn’t even know.
Trump also said last night: “The time has come to give Americans the freedom to purchase health insurance across state lines – creating a truly competitive national marketplace that will bring cost way down and provide far better care.” Eye roll. This standard Republican pipe dream has been around for decades; when the GOP held Congress during the Bush years, it floated a bill that went nowhere. And for good reason, because it would solve nothing. Among other problems, It would hurt the states that strictly regulate health insurers – with dire consequences for sick people.
How so? Because it would allow insurers from lightly regulated states to offer low-cost, skimpy-benefit plans in states that require generous benefits. If healthy people in the strict-regulation states flock to those skimpy plans, the people with serious medical needs would likely face higher costs.
The bottom line is that Trump has no idea how to lead on Obamacare, despite all his rhetorical wand-waving. And congressional Republicans, desperate for direction, are caught between their right-wing base voters (who have been jonesing for repeal since 2010) and the tens of millions of Americans who have gained coverage via Obamacare (and who could potentially flood the ’18 midterms). Indeed, the latest national poll says that only 31 percent of Americans support full repeal.
As a Republican congressman recently warned at a private meeting later leaked to the press, “We’d better be sure that we’re prepared to live with the market we’ve created. Republicans will own that lock, stock, and barrel, and we’ll be judged in the election less than two years away.”
Which brings us back to something Trump said on Monday: “Nobody knew that health care could be so complicated.”
Apparently he was the last to know.