In last week’s debate, President Joe Biden and former President Donald Trump both whiffed on a critical issue sliding under the radar in the race for the White House: the rising costs of healthcare.
It’s not the first such missed opportunity.
Early in his first term, Trump in good faith expressed confidence that a GOP Congress would deliver a “terrific,” “phenomenal,” and “fantastic” alternative to Obamacare. But former House Speaker Paul Ryan and Vice President Mike Pence, who did not have Trump’s back, were preoccupied with merely deep-sixing the 2010 legislation. Instead of designing winning policies to beat Democrats at their game, these players “took a powder on the issue,” per Trump speechwriter Frank Buckley.
Should he win another term, Trump can’t afford a repeat of the 2017 debacle. He needs a gamechanger, a “utility capitalism” solution that doesn’t rest on the faulty notion that nothing is wrong with healthcare sector that free-market reforms can’t fix.
The imperative couldn’t be more pressing. The economic prospects, and access to healthcare, of the largely non-college educated have narrowed dramatically since the early 1990s. Many of these Americans, representing 65 percent of the workforce, don’t feel the government or the market is working for them.
After chronicling the precarious lives of those “struggling,” “floating” or “rising” in “Second Class: How the Elites Betrayed American’s Working Men and Women,” journalist Batya Ungar-Sargon admitted: “I was surprised to find how many of the conservative working-class Americans I interviewed supported something like universal healthcare, Medicare for all, or at least a government-based catastrophic plan.”
Trumpcare, as we might call the new plan, could resonate with working-class anxieties by adopting the 20th-century American model of utility capitalism that targeted prudent regulation to enhance energy utilities, transportation and communications. Specifically, a Ma Bell of American healthcare would make the sector great again, in same the manner that the Bell System, the undisputed 20th century telecom leader, provided universal service at reasonable rates.
The “beautiful” plan would charter Blue Cross-Blue Shield as a regulated monopoly, a national public utility to provide Ford — not Cadillac — coverage to all American civilians (save retirees) without premiums or deductibles. It would only charge modest co-pays for services. It would include dental and eye care, as well as catastrophic insurance. And Congress would have to grant Blue Cross-Blue Shield a critical power missing from the Affordable Care Act: the authority to impose payer-fee schedules on providers of routine care and services, like Medicare does.
Only a wholesale re-booting of the payer system this way can end the bureaucratic nightmare and skyrocketing premiums of the Obamacare landscape. By automatically enrolling with little or no paperwork all working-age American civilians and their dependents, Trumpcare would capture enormous administrative economies of scale and an insurance pool of unprecedented size.
And by elevating citizenship, rather than employment or public welfare, as central to coverage, Trumpcare would save billions of federal dollars by not insuring the tens of millions of foreigners living here illegally and competing unfairly with working-class Americans for jobs, housing and healthcare. Putting Americans first would also remove incentives for illegals to stay, or for millions of others to join them.
Trumping state regulations, the public-private partnership would accrue additional savings by not paying for consumer choices unrelated to physical health, including aromatherapy, hair implants, Viagra, sex-altering surgery, puberty blockers, elective abortions, or birth-control drugs and devices. Nothing would preclude other carriers from selling supplemental insurance for medical non-necessities, purchased by individuals or employers, at after-tax rates.
Completing the transition, Trumpcare would supplant all non-supplemental health plans as well as Obamacare, state exchanges and the State Children’s Health Insurance Plan. Medicare — and Medicaid, for the severely disabled and nursing-home care — would remain in place, as would Tricare, the military health system.
Here’s how to fund the new earned benefit, so it doesn’t bust budgets public or private: (1) a 2.9 percent payroll tax shared by employer and employee, the same rate as the Medicare tax; and (2) corporate income-tax surcharges on “capital-light” sectors of the economy, like Big Tech and Big Finance. Both sectors have made out like bandits, amassing trillions of dollars of reserves via globalist policies, from mass immigration to the outsourcing of “capital-intensive” industries like manufacturing. Also subject to the levy: university endowments that have enjoyed windfalls as the working and middle classes have been squeezed.
Republicans captive to donor-class economics will resist the concept of a Ma Bell health system. Even the think tanks competing for Trump’s policy ear in a potential second administration haven’t spelled out healthcare reforms that would match the Donald’s superlatives. Sounding like Koch operatives, these conservatives think healthcare functions as a competitive market where families can bargain with insurance carriers, mega-hospitals, pharmaceutical giants and medical specialists.
Meanwhile, retirees express no enthusiasm for Medicare overhauls like the “premium support” schemes that fiscal hawks have pushed since Paul Ryan chaired the House Budget Committee. Nor are average workers hankering for health-savings accounts or high-deductible plans.
Whether retired or working, Americans prefer having a third party, like Medicare or an employer, mediate the complexities and technicalities of healthcare. Those working for themselves or employers with limited or no health benefits need Trumpcare, not libertarian hobbyhorses.
Trump will of course have to deliver on other promises, particularly rebuilding America’s industrial capacity, to give workers like the ones with whom Ungar-Sargon spoke their best shot at the American Dream. But unlike 2017, Trump will need to quickly signal his priorities and not allow congressional Republicans to undermine his agenda. Trumpcare would remove all doubt that the Party of Lincoln is the home of the working and middle classes.
Robert Patterson was an associate commissioner for communications at the Social Security Administration from 2017–2019. He also served as a senior speechwriter at the Department of Health and Human Services and the Small Business Administration under President George W. Bush.
