How Will Democrats Respond On Health Care?
This weekend gave Democrats a moment of hope and vindication they have rarely been able to enjoy since President Trump took the White House. They had just seen off the latest attempt by the Republican Party to repeal the Affordable Care Act (ACA) after Friday’s canceled vote, and did so with relatively minimal effort. Indeed, aside from some notable speeches (like the one from Representative John Lewis), the Democratic response to the GOP’s proposed health care bill seemed to be to take the wait and see approach. The strategy worked, as Speaker Paul Ryan’s efforts to push through an unpopular and deeply flawed plan collapsed under the weight of his party’s internal ideological struggles.
This failure automatically sets up health care as a crucial battlefront against the GOP and Trump for Democrats, and one from which they can reasonably hope to benefit. Their next move on health care will be crucial to them doing so, however.
Solidarity Through Non-Action?
Democrats could do more of the same: put up a united front of opposition and let Republican dysfunction do the work for them. Indeed, as Johnathan Martin of the New York Times reports, they seem to already be doing exactly that. This approach is not without its merits: an increasingly unpopular White House and a tribalist GOP are so far doing the Democrat’s heavy lifting. With upcoming battles over tax reform, infrastructure, and the nomination of Neil Gorsuch to the Supreme Court, Democrats might think it imprudent to spend political capital on a battle they have seemingly already won.
The non-action approach carries risks, however. The first is that people will increasingly perceive this type of Democratic opposition, be it on healthcare or other issues, as more of the same from Washington. In applying the same strategy Mitch McConnell oversaw to oppose the policies of President Obama, it will be difficult for Democrats to maintain the moral high ground they hope will give them back power in 2018 and beyond. They might also face pressure from the swell of leftist activism that has manifested following Trump’s election. Worse yet, it might cause many who have turned out to oppose Trump to become disillusioned with politics all over again, something Democrats cannot afford.
The other risk comes from Trump and the GOP, made evident in Trump’s call to Robert Costa of the Washington Post on Friday to announce the GOP bill’s demise (before the GOP could do so officially). If calling a journalist to announce the cancellation of a congressional vote is an unusual move for a president, the explanation Costa was given for the bill’s failure was quite usual for a President Trump; it was the Democrats’ fault and not Trump’s own:
“Hey, we could have done this,” he said. “But we couldn’t get one Democrat vote, not one. So that means they own Obamacare and when that explodes, they will come to us wanting to save whatever is left and we’ll make a real deal.”
This is of course more of the same nonsensical posturing from Trump, and as such warrants its own brief fact check: according to the Congressional Budget Office, there is nothing to indicate the ACA will “explode.” The CBO report published this month predicts stability for the nongroup health insurance market under the ACA, contradicting Republican claims of an imminent collapse.
Even if this weren’t the case, policy failures are always blamed on those who are in power. This is especially the case when those in power have made averting said failures as their mandate, as Trump and the GOP have done with trying to repeal and replace the ACA. But Trump’s comments suggest the right will go back to a tried and true strategy: hang blame on the Democrats for any of the Republicans’ own shortcomings. This strategy cannot be underestimated, particularly with the outsize power the GOP still maintains.
The Vermont Approach?
In order to avoid both pitfalls, Democrats should work to control the narrative on healthcare going forward. This would involve more than just extolling the virtues of the ACA and lampooning Republican efforts to undo it. They must put forth their own legislation, one that can build on the ACA and further the goal of providing universal health care for all. In doing so, they can reliably maintain their position as the party that can solve the health care crisis while casting Republicans’ opposition to their initiatives as indifference to Americans’ health.
This seems to be the thinking behind Senator Bernie Sanders’ proposal for a single-payer health care program he hopes to introduce in the Senate, with his Vermont counterpart, Representative Peter Welch, to do the same in the House. In doing so, Sanders will seek to swing the healthcare conversation back to the left, and will also look to call the bluffs of Trump and other Republicans over their supposed willingness to create a bipartisan health care solution.
In the more predictable political landscape of yesteryear, a single-payer system would be an unthinkable form of socialism for the US. But even in the “limitless possibility” of the Trump era, such a bill still stands no chance. Worse, it might put centrist Democrats, who probably would not support the bill, in a needless bind between different factions of their own constituencies. The pros and cons of a single payer health care aside, such a system is just not something the majority of Americans support; proposing it would therefore probably not give Democrats the foothold they hope to gain.
Is There a Third Way?
Rather than putting forth a classic from the greatest hits of Bernie Sanders, Democrats would be better served to do something that is actually far more radical in today’s political environment: propose a moderate solution. With the ACA looking to remain on the books for the time being, working to fix its flaws will not be the worst thing. And there are flaws that need fixing: the ACA still operates within a system that is needlessly complex; it does nothing to bring down health care spending or improve Medicaid; and its subsidies do not go far enough, leaving some consumers underinsured and others (mostly middle class) with higher premiums than before.
A moderate proposal might seek to increase tax credits to this last group. According to the Economist, the GOP bill, despite its numerous flaws, was still more generous for many middle income earners who do not get insurance from their employers. This seems like a perfect opportunity for bipartisan agreement between Democrats and moderate Republicans peeved at their colleagues from the party’s Freedom Caucus. So too would a plan that reduces costs and improves Medicaid, particularly as states like Kansas are looking at expanding the program. Even Senator Sanders’ previous ideas to lower drug prices could find newfound support in the aftermath of the failed vote last week.
Any bill presented by Democrats would be very unlikely to succeed. The amount of votes they would need from the other side of the aisle is too big, and the chasm between the two parties seemingly too deep to cross. Some on the left would decry even the very attempt to do so as tantamount to an admission of defeat and a legitimizing of the GOP agenda.
They’d be wrong. Whether they succeed or not, leading any effort to make health care work better for Americans will give Democrats an image of competency and morality they can then juxtapose with Republicans’ ineptitude and callousness come election time. Even that is worth fighting for.