If the GOP used to be divided between conservatives and moderates, but is now divided between libertarians and populists, then any legislation as important as the AHCA is next to impossible to achieve. Or at least very, very difficult. Democrats don’t even need to be part of this tower of babel. Although they can’t resist joining in, naturally.

Speaker Ryan’s AHCA will have to modified to have a reasonable chance of passing both Houses of Congress. But in which direction? President Trump – in other words – has to decide what philosophy he wants to support as he uses his executive weight to convince, persuade, and threaten enough House members and every single GOP senator to sign off on the bill.

A GOP conservative perspective, make that a libertarian perspective, admits that more people will be uninsured as a result of repeal. But with taxes, mandates, penalties, regulations, and subsidies eliminated or drastically reduced, private market solutions will drive down premiums and force providers and insurers to create innovative solutions across state lines. And in the end, there may not be anywhere near the number of newly uninsured patients that CBO estimates predict there will be as result of repeal.

A true populist – on the other hand – wants adequate, or better, coverage for just about everyone who is a legal resident of America. That is one tiny step from single-payer universal coverage. The means might differ, but the goals are the same as Bernie Sander’s vision of a socialized American healthcare system.

How the heck do you bridge those two views? When they are essentially inside of the same party? Yes, that’s pushing the populist perspective of Trump Democrats, for example, who basically want Obamacare to be fixed and do not trust its top-heavy centralized system of mandates and penalties. But their views are a long, long way from Senators Paul, Cruz, and Lee.

Who does President Trump listen to, as he decides how to push the as-yet-to-be amended version of Speaker Ryan’s AHCA through Congress? So far, he seems to be more concerned with getting Paul’s, Cruz’s, and Lee’s votes. Repeal as completely as possible now. And then replace with something as conservative, or libertarian, as possible in a month or two. Maybe. Perhaps.

Could the president pivot towards a more populist healthcare proposal? Throughout his campaign, he was clear that he was no conservative when it comes to healthcare. His newfound sympathy for conservative/libertarian concerns is something fairly recent, and definitely post-election. Of course, being a businessman who worries about costs, it would have been fairly straightforward for members of his administration – once they moved into the White House – to lay out some of the unfunded liabilities associated with the ACA. as well as Medicaid and Medicare. That might have helped turn the president.

With healthcare, especially this bill, once you get down in the policy weeds, it’s hard to ever come back up for air and a little perspective. The amount of commentary and policy ideas clash and conflict over differing perspectives on what healthcare insurance actually means. And then what to do, given your view of what health insurance is.

In the end, President Trump will have to expend precious political capital – which he clearly has right now in greater amounts than many critics realize – on legislation which Democrats will try to hang around his presidency. Some want him to walk away from it. Some are willing to listen to him. Some will fight him on this to the end, from both the left and the right.

If the president is able to shepherd some/any version of the AHCA through Congress and survive the mid-term elections as well as do some sort of tax and regulations slashing, he won’t earn a place next to FDR, but he will definitely nudge LBJ out of the way on the presidential stage. Whatever you may think of the big-government policies of either FDR or LBJ. Or the emerging policies of President Trump.

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