Before the Republican proposal to repeal and replace Obamacare collapsed on the launch pad, White House press secretary Sean Spicer assured reporters that the Republicans had "no Plan B."
"There’s Plan A and Plan A," he said. "We’re going to get this done. … This is it."
Ah, but there’s been a Plan B all along! And it’s every bit as morally repellent and politically obtuse as Plan A, which would have knocked an estimated 24 million people off their health care policies, weakened the coverage provided by existing insurance and implemented a massive tax cut to benefit mostly higher earners.
"I’ve been saying for years that the best thing is to let Obamacare explode and then go make a deal with the Democrats," Trump told the Washington Post on Friday when it became clear that Republican party infighting had left the administration short of the votes needed to pass what late-night host Seth Meyers calls "the least popular bill since Cosby."
Trump went on: "The beauty is that (the Democrats) own Obamacare. So when it explodes, they come to us."
Trump said roughly the same thing in a news conference on Jan. 11, less than two weeks before his inauguration: "They own it right now. So the easiest thing would be to let it implode in ’17. And believe me, we’d get pretty much whatever we wanted."
Let’s unpack this Plan B, shall we?
It’s morally repellent for strategic purposes to abdicate responsibility for those who will lose their health coverage if problems with Obamacare — the existing Affordable Care Act signed by President Barack Obama in 2010 — worsen.
Behind these unimaginably vast numbers are real people with real conditions that threaten their lives and livelihoods. And, not to get melodramatic on you, but they will really suffer if the GOP decides to squeeze them in an effort to bring Democrats crawling to the negotiating table.
Trump says it will be "the best thing … the easiest thing" when their treatments stop, their prescriptions lapse, their surgeries are canceled and their debts bankrupt them. For some of these pawns, the setbacks will be permanent.
And it’s politically obtuse to think that such victims, their friends, their families and their communities will blame the Democrats for the chaos.
Since 2010, Republicans have been telling voters they know how to run health care policy better than Democrats. Based in significant part on these assurances, including particularly extravagant promises by Trump, we have Republican majorities in both houses of Congress and a Republican president.
They now own responsibility for the more than 20 million people who rely on the insurance exchanges and Medicaid expansions of the Affordable Care Act.
But luckily — or is it unluckily? — for them, Obamacare isn’t actually exploding, imploding or in a death spiral, despite the urgent GOP rhetoric.
"The Democrats will make a deal with me on healthcare as soon as ObamaCare folds — not long," Trump tweeted at 9:03 p.m. Monday.
He seems to wish. But the recent Congressional Budget Office analysis of Trumpcare also contained what ought to have been a bombshell assessment about Obamacare: It’s working.
"The subsidies to purchase coverage combined with the penalties paid by uninsured people stemming from the individual mandate are anticipated to cause sufficient demand for insurance by people with low health care expenditures for the market to be stable," the agency concluded.
Yes, in places — mostly rural areas — there are problems with insurance companies dropping out of the private exchanges. And those who have enrolled in the exchanges have been older and sicker on average than Obamacare architects had hoped, meaning that premiums have spiked, though not out of line with long-range projections.
Of course, if Trump and the Republicans decline to enforce the insurance-mandate penalties, slack off on recruitment efforts, act to block the subsidies to insurance companies that allow them to keep costs down for low-income customers and otherwise hack away at the program through waivers, Obamacare would indeed "explode" fairly quickly.
But GOP fingerprints would be all over the detonator.
And Democrats will then be well-positioned not so much to save the complex and kludgy Affordable Care Act but to advance the simpler idea to which it points: A national health service that provides the equivalent of Medicare for all.
Obamacare created something of a national consensus that the federal government has an obligation to assure that all Americans at least have access to affordable health care and to attempt to expand the number of people with coverage.
If and when the Democrats come to Trump to make a deal on health care, they may suggest or even demand that, to fulfill his promise of delivering "insurance for everybody," he join the burgeoning fight for single-payer medical insurance as seen in nearly every other civilized country in the world.
Republican congressional majorities would never OK it. But Democratic majorities elected in 2018 based on such a plan probably would.
Let’s call that Plan C, a real way out of this mess.
Podcast: The Mincing Rascals
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