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Three questions


Three huge questions remain after Trump’s signature objective of repealing and replacing Obamacare imploded with a resounding fizzle last week.

First, will the Democratic center stop strutting and cackling and get down to the business of repairing the Affordable Care Act?

Second, will the Republican center stop griping and blaming each other, and get busy working something out with the Democrats?

Third, if reason and common sense finally prevails, and Congress demonstrates an ability to actually govern by passing a true coalition bill that patches up the problems and gets the ACA on its feet in all areas, all tuned up and ready to perform as promised – will Trump sign the bill so we can get on with it?

The Freedom Caucus hard-liners on the extreme right are already beginning to fold their arms and declare their intention to do nothing, in the expectation that Obamacare is about to collapse. Yet, despite what the Republican mantra has been, the overwhelming evidence is that the ACA is not in any danger of imploding or blowing up, and is not in any semblance of a death spiral. Enrollment is up, premiums are up some, but not nearly as bad over-all as the Republicans have claimed, and by most economic measures and in most areas, the act is stronger this year than last. While there are serious problems in some areas, and the problems area are more likely to get worse unless something is done, the predictions generally are that overall, the program is more likely to continue to improve. There is simply no serious question that the ACA is here to stay.

The notion that Trump and the hard liners can just wait for the end to arrive on its own means disappointment for everybody all around. The pockets and neglected areas will suffer, and some of these are good sized areas – a few whole states, for example. If this continues, when the counting-up time comes, the Republicans will get the blame if they sit on their hands and refuse to help, since they are the ones with their hands on the levers.

On the other hand, the left edge has suddenly come to life and has begun to promote the virtues of government sponsored and financed single payer – the concept of Medicare for everybody. They point with sincere enthusiasm to all of Europe and the rest of the industrialized world, where health care is considered a fundamental right, a responsibility of the government, and otherwise free to all. Every other country uses some form of government sponsored, single payer except us. And we even use it for our most precious – our children, our elders and our injured warriors. Senator Bernie is already on the stump, and others are beginning to rumble. If a groundswell gets started, and the gals in their funny hats decide to climb aboard, it may be difficult to redirect the effort.

The Democrats could not get single payer, or Medicare for everybody, or government sponsored health care, even out the starting blocks the last time this subject was on the table, eight years ago when the ACA was actually adopted, and when the Democrats controlled both houses of Congress and the Presidency. They barely got the ACA adopted, and had to use the ruse of budget reconciliation to get that done. It would seem the height of political naiveté to believe that now, just because the right wing got dumped for being too far right, that there is some momentum to look at a far left solution. By everything that is real and practical, the solution has to come from the middle.

This being said, there are still plenty in Congress – both houses – who march in the vicinity of the middle and who, if their leadership will get out of the way, could pull off a deal with no more consternation than a walk in the spring rain. The measures needed to improve the ACA are well known. Some were actually included in the Republican bill. If deals are honored, if markups are constructive rather than tactical sabotage, if the House drops the Hastert rule and the Senate suspends the filibuster rule – no problem.

Actually, all that really has to happen is for both sides to give up ownership of the fix and of the right to blame. Just make it a true coalition effort.

Pies in the sky? Probably, unfortunately. One drumbeat of the Freedom Caucus, for example, has been to get the federal government out of the picture and leave it to the states. Look at our own Idaho legislature; it has completely bottled up every single effort by anybody to address the issue of healthcare for the uninsured in Idaho. It has refused to go along with the expansion of Medicaid under the ACA, and has thereby lost hundreds of millions of dollars to Idaho. Our Congressional delegation stands in a tight circle right in the center of it all, resolute, eyes tight shut, with dueling pistols at the ready, pointed inward. The politics may simply be insurmountable.

And then, even if it did happen over all this hoopla, the $64 thousand final question would still have to be, will the Old Fool sign the damn thing? Any bets? Any predictions?

Anybody holding their breath?

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