Back in 2009, I was seriously not crazy about the messy mechanics of Obamacare, but then again, neither was Obama. Can anyone doubt he would have preferred a single-payer system? He just perceived, correctly, that getting anything passed would require the political acquiescence of those who already had insurance. And their bottom line was to keep what they had – even, perversely, when it was woefully inadequate. (It would seem that many Americans were more afraid of change than being uninsured.) When it finally rolled out, the greatest success stories with the ACA involved Medicaid expansion to those who were not previously covered, particularly in those states that took on the responsibility of outreach. Kentucky was an excellent example of tens of thousands of previously uninsured who were quite happy to be covered as long as a social worker signed them up for it. (This same population voted heavily for Trump – but that may be less of a contradiction than it seems. Read on.)
The complexity of the ACA was why, at the time, I thought it made much more sense to simply reduce the age of eligibility for Medicare every year by 5 years. In 2010 it would have been 55; 2011, 50; 2013, 45, etc. Combined with letting kids stay on their parent’s insurance till 26, by this year, everybody would have been covered. I’m sure Obama and his legion of health economists thought about this approach, but I bet they feared the new system would be too easily defined as “socialized medicine.” Obama wrongly imagined that if he based the ACA on Romneycare, he was indemnifying himself against such accusations. Instead, we got the death-panel summer of 2009 and the disastrous midterm “shellacking” of 2010. Soon enough, Obama grasped that his dream of bipartisanship consensus was not an oasis, but a mirage.
The five-year incremental approach had the best chance of working because Medicare already had the infrastructure in place to absorb new beneficiaries. They could have hired new employees to expand it, in fact, from the same insurance companies that would have been laying them off. The thorniest challenge would have been what it still is, really. How do you get businesses to pay the same amount into a single-payer system that they currently spend on employee healthcare? Democrats have been so tarred and feathered by the “tax and spend” label that of course it makes them nervous to overtly tax and spend. (Meanwhile, the Republicans got away with throwing several trillion into a pointless war as big government-hating Americans proved incapable of understanding that defense spending is big government at its most wasteful and unproductive.)
Healthcare is complicated – as only Trump did not know. So is every single major issue facing the United States, of course. In fact, there may have never been a worse time in history to choose a President who makes George W. Bush look like an intellectual giant over a woman with binders full of plans to tackle every problem. So how is it that the traits that should have been Trump’s downfall are the very same that won him the election?
I’ve proffered a few theories in this regard, examining how his obnoxiousness and incoherence were experienced by his voters as authenticity and truth-telling. To these theories I add another: Donald Trump manifests a rejection of complexity for millions of people who feel overwhelmed by it in so much of their lives.
In one generation, we have gone from a country of answering machines to a nation of smart phones. Everyone uses the internet; only a few brave souls reject TV or Facebook. We are operating with the very same brains that conducted immeasurably less complicated lives for millennia, but have been making hemispheric leaps of mind-bending technological and social progress. For every person at the forefront of this rapid change, there are many more just trying to keep up. Older, white, less-educated Americans at the core of Trump’s support felt left behind all right, but less economically than psychologically. He emerged as a giant orange reset button they only had to push in the voting booth to feel great about themselves again.
The master con artist proclaimed quite sincerely that there was no problem that couldn’t be fixed in four words or less. Restore law and order. Deport the undocumented. Cheap but great healthcare. Reduce regulation. Destroy ISIS. Bumper-sticker answers from a bumper-sticker brain.
To elevate this ignorant buffoon to the highest office in the land, all that was required was one of the last untechnological acts in the public sphere– going into a precinct, filling out a ballot, and slipping it into a box. Voting itself put the most die-hard Philistine on par with the trendiest coastal hipster. Take your app and shove it, millennial.
This complexity-phobia is why, of all the lessons learned by Trump’s ascendance, the Democrats should absorb one above all in winning back the retrievable portion of his voters: Keep it simple. We may know that Medicare-for-All will be plenty complicated to implement, but right now the idea of it only needs to be easy to understand.
It may be dawning on the voters who fell for this carnival barker that perhaps it’s not a good thing to be smarter than the President, but they still require solutions without too many syllables. That doesn’t mean lying, but it may mean simplifying.