“If you want to make God laugh,” Woody Allen once famously said, paraphrasing a Yiddish proverb, “tell him about your plans.”
That’s not an issue for President Donald Trump, at least not on health care.
He’s been promising a health care plan since he started running for president, often with superlative adjectives attached, and yet has never produced one. His lack of a proposal was a stumbling block in Tuesday’s debate and plays into a broader, long-standing Republican vulnerability on health care.
Polling tends to show that, far and away, the three most important issues to voters are the economy, Covid-19 and health care. Trump leads narrowly on the economy and trails on the other two. To the extent that issues play a role in a Trump defeat in November, health care will have had some hand in it, and he’s done little to inoculate himself, in fact has gone out of his way to expose himself.
His administration backs a lawsuit that seeks to strike down Obamacare, including its popular protections for people with preexisting conditions. This allows Democrats to say—and they say it all the time—that he wants to destroy Obamacare. They believe this line of attack is so useful that it has also become their main argument against confirming Amy Coney Barrett, lest she rubber-stamp the anti-Obamacare lawsuit once she’s on the Supreme Court.
Never mind that the suit is very unlikely to succeed. The background is that in a previous case, the Supreme Court upheld the individual mandate in Obamacare as a tax. Then, Congress zeroed out the tax. The current case argues that the individual mandate therefore can no longer be upheld as a tax and further—this is the real stretch—that if this now toothless mandate is thrown out, the rest of the law has to go as well. There’s no reason to believe that the conservative justices would undertake this legal adventure.
But this makes the politics a worst-of-both-worlds scenario for the White House. By backing the suit, it opens itself up to the attack prior to the election that it will eliminate protections for preexisting conditions, without having any realistic chance of winning when the court takes up the case after the election.
It would help at least to have a plan, and that’s Trump’s instinct. But his supposedly imminent health care plan has become as meaningful as the various versions of “infrastructure week.”
Coming up with a health care plan should be something within his control. It’s not like, say, promising to create 10 million jobs, a pledge that would depend on circumstances not fully under any president’s control. Drafting a plan, at bottom, requires only a consensus among some wonks, a word-processing program and a printer.
No one would have bet at the outset that the administration would have in hand two historic Middle East peace agreements—namely, the United Arab Emirates and Bahrain normalizing relations with Israel—before having one health care plan. But here we are.
It’s not as though there aren’t options (and it should be noted that the administration has adopted worthy, piece-meal changes to nudge the health care system in a more free-market direction). There’s the old House Republican plan from the Obamacare repeal debate in 2017, and a plan from The Heritage Foundation that is tailor-made to be picked up by the administration. In fact, it’s been promoted in an op-ed titled, “A Health Plan for President Trump.”
But there hasn’t been a consensus within the administration. At least one faction, once associated with former acting chief of staff Mick Mulvaney, opposes any plan at all. It reflects vintage Tea Party thinking circa 2014 that Obamacare needs to be repealed and not replaced.
In addition, once you get into brass tacks, health care policy involves trade-offs that are all politically perilous. If you send the spending in Obamacare back to the states, how will the individuals currently receiving Obamacare subsidies react? Alternative conservative reform plans involve their own far-reaching, intricate policy changes that can’t be undertaken lightly.
So the path of political least resistance is to commit to nothing, which the administration has done. It has attempted to compensate for its lack of a plan with an executive order committing to come up with a way to cover people with preexisting conditions at some future date. The president has touted this as a historic act, even though it’s only a more official version of Trump’s prior promises.
There’s no doubt Trump is more populist, both in manner and substance, than his Republican predecessors. But health care is an area where his populism is insufficiently realized. Seeking to repeal Obamacare without bothering to tell people how it’s going to be improved on is what you’d expect from a stereotypical Republican, and it’s been Trump’s posture for four years.
God might scoff, but it’d be better to have a plan.