If you want a case study in why Donald Trump isn’t serious about governing ― and how that attitude is typical of the Republican Party generally ― take a close look at the conversation about Obamacare that’s unfolding in the presidential campaign right now.
It started on Tuesday, while Bill Clinton was speaking to Democrats in Flint, Michigan. When the former president started talking about the Affordable Care Act, the 2010 health care law that President Barack Obama signed and that Democratic nominee Hillary Clinton supports, he decried the plight of people facing higher premiums and less generous coverage because of the law. “It’s the craziest system in the world,” he said.
The comments lit up social media, and it didn’t take long for the Republican presidential nominee to pounce. “He absolutely trashed President Obama’s signature legislation,” Trump said during a rally on Tuesday.
Trump has made the argument several times since ― as have his allies and pretty much everybody in the GOP, for that matter.
But as HuffPost’s Jeffrey Young pointed out, Clinton didn’t actually trash the whole program. On the contrary, he had started his comments by praising the law’s many accomplishments ― chief among them, helping something like 20 million people get health insurance, thereby bringing the nation’s uninsured rate to a historic low. The comments he made were about one particular group of people: those who make just a little too much money to qualify for the program’s financial assistance.
Their problems are real. One of Obamacare’s main goals was to help people buying coverage on their own, rather than through employers. Previously, insurers could charge higher premiums or deny coverage altogether to people with pre-existing conditions. And the policies they sold frequently had big gaps, leaving people facing massive, potentially ruinous bills when they needed serious medical care.
Neither Trump nor the Republicans have a serious alternative that would provide anything resembling the same level of benefits.
Obamacare tries to stop all of that, by requiring insurers to sell to everybody, at uniform prices, and to include “essential benefits” like prescription drugs and mental health coverage in every policy.
This has been a godsend for people who couldn’t get insurance before, or pay their bills if sick. It has also raised premiums, since insurance must cover more services and be available to people likely to use them. By design, the law shields people from these increases with tax credits, worth as much as thousands of dollars a year. But more affluent households get less assistance, or none at all ― and particularly for the lucky ones who could find cheap plans before, the new costs are a shock.
Hillary Clinton didn’t need her husband to tell her about people in this situation. Like Obama, the former secretary of state has been talking about them for a while ― and proposing to help them through a combination of policies that, in theory, would make prescription drugs cheaper and reduce expenses for people now paying the most out of their own pockets.
These are the sorts of adjustments that the law’s architects always understood would be necessary. Tom Harkin, a former Democratic senator from Iowa, famously referred to Obamacare as a “starter home” that would require further work. That phrase was emblematic of the attitude the law’s supporters have carried through to the present day. In just the last few months, both Obama and Hillary Clinton have written lengthy articles ― one each in the Journal of the American Medical Association and the New England Journal of Medicine ― hailing the law’s progress but also pointing to its shortcomings and outlining their ideas for addressing them.
The contrast with Republican rhetoric could not be more stark.
One reason Obamacare has such a kludgy design is that Obama and his allies had adopted a coverage scheme, heavily reliant on private insurance, that some conservatives had championed and that a Republican governor ― Mitt Romney of Massachusetts ― had signed and implemented. The hope was that this method would help health care reform attract bipartisan support.
Republicans in Washington wanted no part of it. Instead, they opposed the law en masse, wildly distorting its features (by, for example, claiming it had “death panels” that would cut off care to the elderly) and predicting that it would wreck the economy and cause the budget deficit to explode.
None of these dire predictions came to pass. But Republicans ― whether you’re talking about individual congressional candidates or the man at the top of the ticket ― haven’t changed their tone. Their rhetoric remains as hyperbolic and apocalyptic as ever, not to mention one-sided.
Listen to Trump, and you’ll hear all about what a “disaster” Obamacare is. What you’ll never hear is even the slightest acknowledgement that, whatever its flaws, the law has also done some good ― that it has helped millions of people get coverage, and that it has ended insurance company practices that the vast majority of Americans had long opposed. Trump’s campaign website instead claims that the law has “raised the economic uncertainty of every single person residing in this country.”
Of course many Republicans have serious, principled objections to the health care law, as well as the new steps the Democratic nominee has endorsed in her presidential campaign ― steps that, they believe, would double down on a failed approach to health care. Trump may think the same way, although he has said enough contradictory things to make his true intentions impossible to divine.
But what neither Trump nor the Republicans have is a serious alternative that would provide anything resembling the same level of benefits.
The plans circulating among conservative intellectuals ― a version of which Trump appears to endorse with some vague talking points on his website ― would dramatically scale back the new regulations on insurance, reduce what the government spends to help people get coverage, and eliminate new taxes (mostly on the wealthy) that pay for the program. In effect, they would wind back the clock, partly or entirely, so that America’s health insurance system looks like it did before Obamacare came along.
In that system, young and healthy people could sometimes get very cheap insurance. But the coverage was frequently threadbare and a lot of people had no access to policies at all. It was a system that, overall, left many more people suffering ― financially and medically.
If Trump and the Republicans were merely willing to accept the basic structure of the Affordable Care Act ― a structure, remember, many of them once supported ― then they could find plenty of Democrats willing to compromise over further changes to the law. It would take only a little bit of negotiation to hammer out a bipartisan reform package that drew on proposals from both conservatives and liberals, while helping the people still struggling with health care costs ― the ones, in other words, Bill Clinton was talking about in Flint.
But neither the GOP nor its presidential nominee has ever shown that kind of attitude. It’s one of the ways in which Trump, for all of his bluster, turns out to be an utterly conventional Republican.
Editor’s note: Donald Trump regularly incites political violence and is a serial liar, rampant xenophobe, racist, misogynist and birther who has repeatedly pledged to ban all Muslims — 1.6 billion members of an entire religion — from entering the U.S.