Friday, April 14, 2017

Trump is too ignorant to do health care

During a Wall Street Journal interview, President Trump talked about what could theoretically be a highly risky but successful strategy to get a “win” on health care. He admitted he has broad powers to sabotage the Affordable Care Act exchanges and may threaten to cut off subsidies for millions, so “the Democrats will start calling me and negotiating.”

The real takeaway from this bold admission is not that Trump is considering this strategy, but that he is so ignorant about health care he doesn’t even understand his own strategy.

Theoretically scaring Democrats into accepting a health care compromise might have worked at some point, but it required two things.

First, Democrats need to fear that if the exchanges continue to have problems, voters will blame them at least as much or more than Trump.

This was already tough because polling from before this interview shows voters are more inclined to blame Trump for any problems with the ACA going forward. Of course, polling about how people think they might react two years from now to future hypotheticals is a weak predictor. Obamacare was the Democrats' law, and conservatives are good at spin. Trump’s team could quietly undermine the exchanges with a slew of small regulatory changes that he claims are meant to to help, but actually hurt by increasing uncertainty. The key part, however, is doing it "quietly." People don’t really understand insurance regulation, so as long as the changes subtle, it would create a dicey blame game. Democrats would say Trump ruined the exchange, Trump could say he tried to save them but they were too flawed.

Instead, Trump told a major national publication that he may actively sabotage the law in a big and public way. Now I doubt Democrats are too worried they will get blamed.

Second, to work the offered compromise needs to be better than just letting the ACA exchanges fail.

Using executive authority, Trump could do real damage to the exchanges, making insurance more expensive and unobtainable for millions. So if Trump offered Democrats a compromise that would produce results worse than what we currently have yet better than how it would be if Trump undermined the exchanges, Democrats might feel compelled to think about it.

Instead, Trump has thrown his weight behind the American Health Care Act. If approved it would produce a system even worse than one where Trump sabotages exchanges. Even if some of the exchanges struggle, the ACA’s Medicaid expansion would remain. Democrats are slowly coming to accept that the Medicaid expansion was the best part of the ACA and did the most good. The AHCA would make the individual market terrible and slash Medicaid.

This is not a complicated analysis. This is deal-making 101. If you want to try to coerce someone into making a deal, the deal needs to be better than the threat. You don’t threaten to scratch someone’s car unless they set it on fire, especially while on camera.

Trump's statement suggests he is totally ignorant about what his health care bill would do, what Democrats want, how Congress works, and what he is actually threatening. This is not merely a risk strategy; Trump doesn’t even know enough to understand his own strategy. It is tough to see how he succeeds with any legislation.

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