Trump: Come to think of it, we don't need to do health care until after I'm re-elected

This is being portrayed as a “pivot” or whatever the Beltway crowd calls it, but it was never going to be anything other than this. With a Democrat-controlled House, the only replacement for ObamaCare that’s possible is total socialized medicine.

Now, what this does is set up health care as a defining issue of the 2020 campaign. That is not going to make Republican campaign consultants happy, since they’re convinced Democrats own the issue and Republicans can never win running on it. The 2010 and 2014 mid-term results would suggest otherwise.

But in both of those years, Republicans were essentially running against ObamaCare rather than running for anything of their own. That’s not going to work in 2020. There’s going to have to be a serious proposal that can work, and that the country can get behind. Thus far that’s been a big problem for Republicans because they can’t even agree amongst themselves what the plan should be.

But the country needs something better than ObamaCare, and we don’t need it to be anything that comes out of the head of Bernie Sanders, so maybe Trump believes it can work this time because the variable his . . . Donald Trump:

Everybody agrees that ObamaCare doesn’t work. Premiums & deductibles are far too high – Really bad HealthCare! Even the Dems want to replace it, but with Medicare for all, which would cause 180 million Americans to lose their beloved private health insurance. The Republicans…..

— Donald J. Trump (@realDonaldTrump) April 2, 2019

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….are developing a really great HealthCare Plan with far lower premiums (cost) & deductibles than ObamaCare. In other words it will be far less expensive & much more usable than ObamaCare. Vote will be taken right after the Election when Republicans hold the Senate & win……

— Donald J. Trump (@realDonaldTrump) April 2, 2019

….back the House. It will be truly great HealthCare that will work for America. Also, Republicans will always support Pre-Existing Conditions. The Republican Party will be known as the Party of Great HealtCare. Meantime, the USA is doing better than ever & is respected again!

— Donald J. Trump (@realDonaldTrump) April 2, 2019

I guess this begs the question: Which Republicans are developing this plan?

It doesn’t sound like Mitch McConnell is in on it, and if any relevant committee chairs are drafting up legislation, that’s news to me and probably to them. The White House is almost certainly going to take the lead on this, and that might be a good thing in terms of the substance we’re likely to see. The White House has more free-market thinkers than you might have expected given Trump’s lack of any pedigree with supply-side economics.

But what are the chances Senate and House Republicans running for re-election get behind a Trump plan en masse during the 2020 re-election campaign, especially as the media savage the plan for reasons real or imagined and purple-state Republicans get awfully nervous about their re-election chances.

Remember, there are 23 Republican senators who have to defend their seats in 2020, compared with only 10 Democrats. Most don’t appear to be all that vulnerable, but the GOP would only need a net loss of four seats to turn control of the upper chamber over to Charles Schumer. If Trump releases a plan the media brands as “TrumpCare” and then attacks in all the ways they usually do, are vulnerable incumbents really going to campaign on the promise that they’ll vote for “TrumpCare” on day one of the new congressional term?

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And yet there’s a lot I like about the idea that the 2020 campaign should be about a real issue that matters to the American people, and health care certainly is that kind of issue. Health care policy in the United States wasn’t really right before ObamaCare. There was way too much emphasis on having everything “covered” by third-party payers accessed through yet another party, which was your employer. All this made it prohibitively expensive for people who preferred to just pay for their own health care with their own money, since all the added bureaucracy in the system added costs under the guise of making it “free”.

And the incentives were perverse. Shielding everyone from the true cost of care made them more cavalier about consuming services they may or may not have needed, and incentivized doctors to push procedures and medications, less on the basis of patient need and more on the basis of what insurance would cover.

The Bush Administration tried to make it better by expanding health savings accounts, but the tax code still favored employer-based insurance above all else, and even simple efforts to provide individual expenditures with the same tax treatment meant with too much resistance.

When the GOP Congress of the Bush 43 era failed to enact real free-market reforms to all this, it left the perfect opening for Obama to come in and try to blame the insurance companies for everything from high premiums to the number of people who were uninsured. The insurance companies weren’t really good guys, but they were just responding to the incentives in the system.

And even at that, ObamaCare was never popular with the public. Democrats shoved it through in 2009 and 2010 because they had a rare 60-seat Senate majority and they were never going to have a better chance. The public punished them for it in the mid-terms but here we are a decade later still stuck with it.

It’s a bad system, although it’s not as bad as the government-run systems Democrats are now willing to admit they’ve wanted all along. Republicans owe it to the country to come up with something better. I do not fault Trump for thinking Republicans should propose this and try to win a majority to do it.

But I do question whether actual congressional Republicans possess the temerity to pull it off. They’ve done nothing so far to suggest they do.