1994, 2010 and (?) 2018

Right after taking office in 1993, Bill Clinton — a Democrat with a Democratic Congress — decided to take on the issue of health care policy, putting Hillary in charge. She came up with an innovative but highly complex plan that failed politically, resulting in the Democrats losing the midterm elections in 1994.

Right after taking office in 2009, Barack Obama — again, a Democrat with a Democratic Congress — ignored past history and did the same thing, reportedly fulfilling a promise made to the Kennedys in return for their backing him instead of Hillary in the 2008 primaries. Granted, he did succeed, but again at a huge cost, with the Democrats losing the midterm elections in 2010.

If I remember correctly, originally health care was not a major issue with Trump. And he was a strong supporter of preserving Social Security, a very un-Republican view, and one that is arguably close to the goal of Obamacare in spirit. But like Obama, he had to make a deal to get the support of powerful elements of his party, and he eventually made the repeal and replacement of Obamacare a big goal. And now he could end up suffering the same consequences as did Clinton and Obama in the midterm elections.

The people Trump championed during the election campaign, the little guy, the working people — are exactly the types of folks who tend to be enjoying the benefits of Obamacare today. Will he abandon them?

Let me offer three obvious (to me, at least) facts:

• No one, even the most extreme Republicans, wants to see people dying in the streets. The federal government does have a role, indeed a responsibility. It’s too big for the states, and even if the feds give them block grants, some states, say in the South, would adopt draconian policies.
• Many people, especially the stereotypical Trump supporters, live paycheck to paycheck. Tax breaks, health savings accounts and the like are useless to this large group of people. It’s an insult to offer them such things, a let-them-eat-cake solution.
• Obamacare was a bold step that filled a void that desperately needed to be filled. But it was built on various assumptions that apparently were shaky. It is not sustainable in its current form. Already some insurers have withdrawn from certain markets.
• The Republicans now are making their own shaky assumptions, e.g. that a 30% penalty, for those who forego insurance but then suddenly need it, is the right “price” for not doing their part to support the system. Really? Why shouldn’t it be 5% or 50%, say? No one knows.

So what is my solution, you ask? Don’t be silly; of course I don’t have one. This is nowhere near my area of expertise. It’s possibly the most complex policy problem our nation has ever faced. But doing nothing is not an option.

Nevertheless, I do have one concrete suggestion, for both political parties: Borrow from the software engineering notion of use cases. Set up 5-10 examples, such as a working single mother,a small business owner, a professional in her 50s who simply can’t get a decent job because of her age, a salaried middle manager with a severely autistic child, a new college graduate working at Starbucks while trying to find work, and so on. In every debate on health care policy, both/all sides of the debate would address the question of how each of these use cases would fare under the policy they advocate.

In 2009, the biggest tragedy was the Obama never tried to sell to the American people to need for big reform. And the second-biggest tragedy was that he OVER-sold it, e.g. with the famous “You can keep your present insurance policy and present doctor” line. Both the Democrats and Republicans need to explain to the nation how they view the problem and how to solve it.

But speaking in abstractions — e.g. invoking the glories of the free market — is unacceptable. Tell us, all you guys on the Hill with your free, high-quality health care, exactly what would happen in each of those use cases under your plan? Give us real analysis with real people, no superstition. Then we might actually be able to solve the problem, and for once people might think Congress is concerned with the well-being of the people after all.