By Stuart H. Shapiro
and LeRoy Goldman
The most important question facing Donald Trump is whether he has the vision and the courage to serve as president of all Americans, as he proclaimed during his victory speech, or whether he will take the path of both his immediate predecessors and serve only the half of America that elected him. That choice is monumentally difficult. You only have to look at the recent protests in Philadelphia and elsewhere to witness the fear, anger, and dismay of those who won't accept the result of a free election that dealt them a surprising and profound loss.
What Trump chooses to do right out of the gate will set the tone for all that comes after. If he's going to go big, as he likes to do, then he's got to start big - and nothing is bigger than Obamacare.
President Obama chose, unwisely, at the outset of his administration to embark upon health-care reform. By jamming a bill through the House and Senate without careful consideration of the specifics of the legislation, he and the Democrats in Congress were both naive and unwise, and they paid dearly for it. Their tunnel vision cost them the House in 2010 and the Senate in 2014. Since then, Obamacare has torn the nation in half. It has become a rallying cry for the right and a symbol of progressivism for the left. On Nov. 8, its chickens came home to roost on the White House lawn.
The Obama administration's assumptions about its costs and enrollment in Obamacare have been wildly wrong. The legislation is named the Affordable Care Act, and it's anything but that for those who have to pay for it. Today, it teeters on the brink of collapse as premiums skyrocket and insurance companies flee its marketplace.
The Republicans, for their part, have been just as unwise and bullheaded. The House has voted symbolically more than 25 times to repeal Obamacare, all to no avail. The Senate expended considerable energy and used the arcane budget reconciliation procedure to get a repeal bill on Obama's desk, knowing full well that he would veto it.
Now, with the election of Trump, most Republicans are licking their chops for revenge wanting to light a bonfire fueled by the thousands of pages of Obamacare. If Trump buys into that mean-spirited strategy, he will sacrifice his chance to be a transformational president. He must chart a different and better course.
What is to be done? Here are the essential elements that Trump and Tom Price, the nominee for secretary of Health and Human Services, must make part of a of a bipartisan solution: Terminate the Obamacare mandate that forces Americans to enroll in it. Terminate the program's tax penalties. Abolish the crumbling exchanges. Authorize insurance companies to sell policies across state lines. Expand health savings accounts. Enact tort reform. Allow young people up to age 26 to remain on their parents' policies. Don't let insurance companies deny coverage to people with preexisting conditions. Deem eligible for Medicaid anyone now covered under Obamacare if they cannot find or afford coverage in the private marketplace. These policies would hold harmless the 21 million people now covered by Obamacare.
After developing the broad outlines of this plan, Trump needs to explain it to the nation in a prime time address. Then he must take congressional leaders and key committee chairmen, from both sides, to Camp David. He and Price can present their plan, say they are open to improvements, stressing the need for bipartisanship, and make clear that the helicopters back to Capitol Hill will not be available until a deal has been reached. That was the bipartisan way the legislative process worked when each of us led the U.S. Senate Subcommittee on Health, and how it needs to work today.
If the new president does that, a new day dawns in Washington, one that is long overdue, and one that will be welcomed by the vast majority of the American people, no matter whom they voted for on Election Day. Indeed, if successful, Trump would prove that he is a master deal maker in the league with Lyndon Johnson, Tip O'Neill, Ronald Reagan, and Ted Kennedy.
Stuart H. Shapiro is a former Philadelphia health commissioner. firstname.lastname@example.org
LeRoy Goldman is a former associate director at the National Institutes of Health. email@example.com