Tags: Healthcare Reform | Immigration | Medicare | Polls | coalition | single-payer

Political Strange Bedfellows Could Make Trump's Agenda Succeed

Political Strange Bedfellows Could Make Trump's Agenda Succeed
Sen. Elizabeth Warren, D-Mass. speaks with Sen. Bernie Sanders, I-Vt. at the Senate Health, Education, Labor, and Pensions Committee hearing with governors to discuses ways to stabilize health insurance markets‚Äč, on Capitol Hill in Washington, D.C., on Sept. 7, 2017. (Jose Luis Magana/AP)

Tuesday, 19 September 2017 11:50 AM Current | Bio | Archive

President Trump's decision to experiment with bipartisanship has generated considerable appreciation, not least from Christopher Ruddy. The deals have been good steps towards resolving important problems: hurricane relief, the debt ceiling, and DACA.

It's possible the fun is just beginning. The biggest possible bipartisan coup would replace Obamacare with a single-payer insurance system. The idea will horrify many Republican politicians. Current Democratic leaders — Nancy Pelosi, Chuck Schumer, and Hillary Clinton — will have grave doubts about its feasibility. But the current situation presents an opportunity for a deal that a world-class opportunist like Donald Trump might be able to pull off.

The president would need to work with all Democrats, including those not presently holding leadership positions — Sens. Bernie Sanders, I-Vt., Elizabeth Warren, D-Mass., and Rep. John Conyers, Jr., D-Mich. Conyers has repeatedly introduced single-payer legislation in the House. Sanders has long advocated taxpayer-funded insurance covering everybody, recently introducing Medicare-for-all legislation in the Senate with enthusiastic support from Warren and a dozen other Democrats.

The Sanders bill does not specify how to finance Medicare-for-all, and his campaign proposals grossly underestimated the tax increases needed to pay for it. Services accounting for a sixth of the GDP can't be financed with small tax increases or with increases only on the rich; there aren't enough rich people to "soak."

The political obstacles to Medicare-for-all are formidable. Polls indicate majority support, but the majority disappears when people are told it would require increased taxes. The total system would cost much less than the current system, since administrative costs for today's Medicare are a tiny fraction of those for private insurance. Most people's increased taxes would therefore be more than offset by savings in their other expenses.

But many people insured through their employers are unaware how much this insurance is costing them in lower wages. an unawareness bolstered by the fact that people do not pay income tax on the value of this insurance. Vested interests that would be harmed by single-payer will exploit this unawareness in well-financed campaigns against the proposal. Many people will be comparing currently invisible costs with the very visible taxes that would eliminate those costs as well as what they now pay directly.

Even though most people would gain financially when increased taxes and reduced direct and indirect insurance costs are netted out, getting people to believe this will be difficult. This is where Donald Trump's talents as a salesman could make the difference between success and failure.

The bill Sanders just introduced has its problems. One was recently pointed out to me by a doctor who has long advocated single-payer. Sanders wants the new system to be introduced gradually, with the Medicare eligibility age reduced by 10 years every year (plus youngsters under 18 being covered immediately) until everyone is covered after four years.

Although gradualism in major changes is often desirable, here it would aggravate transitional problems. Some big changes cannot be gradual. We cannot cross the Grand Canyon in two steps, as someone once put it.

Though his bill is imperfect, Sanders has performed a public service by getting discussion of Medicare-for-all on the national agenda. Before enacting such a major reform, Congress would need to subject proposals to rigorous due process of legislation: committee hearings, testimony from governmental and private experts, weighing the pros and cons of foreign insurance systems. Reforms impacting one-sixth of the G.D.P. must be done with extreme care to avoid the devils that can lurk in details. The result should be legislation far better than Sanders' bill.

As President Trump likes to ask, what would be in a Medicare-for-all deal for him?

It would be a major accomplishment in which his active participation was vital. It would help many people whose economic despair prompted them to vote for him. It would fulfill his campaign promise to replace Obamacare with something covering everybody. It would do more for disadvantaged minorities than any other conceivable government program. It would save most people money and reduce the fears of even well-insured people that medical expenses might bankrupt them.

Despite current opposition by most Republican leaders and the doubts of some Democrats, if President Trump can convince voters that an improved Medicare-for-all would save them money and improve their lives, Congressional Republicans would have to join Democrats in enacting it.

It is often said that politics makes strange bedfellows. Here is an opportunity for a strange bedfellows coalition.

An obvious first step Mr. Trump could take: invite Sanders, Warren, and Conyers to a private dinner at the White House. The political uproar that this would cause would be a joy to behold.

Paul F. deLespinasse is Professor Emeritus of Political Science and Computer Science at Adrian College. He received his Ph.D. from Johns Hopkins University in 1966, and has been a National Merit Scholar, an NDEA Fellow, a Woodrow Wilson Fellow, and a Fellow in Law and Political Science at the Harvard Law School. His college textbook, "Thinking About Politics: American Government in Associational Perspective," was published 1981 and his most recent book is "The Case of the Racist Choir Conductor: Struggling With America's Original Sin." His columns have appeared in newspapers in Michigan, Oregon, and a number of other states. To read more of his reports — Click Here Now.

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Despite current opposition by most GOP leaders and the doubts of some Democrats, if Mr. Trump can convince voters that an improved Medicare-for-all would save them money and improve their lives, Congressional Republicans would have to join Democrats in enacting it.
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Tuesday, 19 September 2017 11:50 AM
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