By Colin Hanna
Obamacare is about to crash, and the Republican replacement never got off the ground. Pundits everywhere declare that this is a disaster for President Trump, possibly even fatal to his reelection prospects and the Republican majorities in both the House and Senate.
I suggest that there could be an entirely different, almost opposite, scenario: The defeat of the American Health Care Act could position the president for a massive, unexpected win that would firmly establish himself as the Disrupter in Chief.
Two things we know for sure about Trump: He likes to shake things up, and he has enormous pride in his own name. The bill that failed was the product of Republican House leadership. It was not the product of Trump, and it didn't deliver on his campaign promises. Although he did the right thing by backing congressional Republicans' efforts initially, he never really invested his personal capital in it.
Now he can create his own, unique health-care solution instead. Because he loves the idea of being a nonpolitician, a disrupter, he could propose something that is unlike any of the plans offered by either the Republican or Democratic party establishments. His plan could be so out of the expected norms that it could even get bipartisan support, something that appeals to him, and rightly so.
Here's one such plan. It begins with an ID card - one destined to be known as the Trump Card - that would bear a photo and biometric markers that are not easily counterfeited. It could also be used as proof of citizenship or legal status for voting and employment.
Conservatives would need to get over their long-standing objections to a national ID card, but they'd finally get something to address their concerns about voter fraud and illegal workers. It could be adopted by states as their Voter ID standard. It could also distinguish between citizens and noncitizen legal residents, students, or other visitors, and put noncitizens on a zero-subsidy basis if Congress decides that's what taxpayers want. Liberals would need to concede that an easily obtained, secure, and free identification card is not inherently discriminatory.
The card then could be used as the means of payment at a private sector primary health-care site like a walk-in neighborhood clinic that does not make appointments. The neighborhood clinics would employ nurse practitioners rather than medical doctors as the first line of patient contact, and prescribe only generic drugs or over-the-counter medications. Referrals to specialists would require physician and insurance company approval.
The private sector insurance market would coordinate all billings and payments, modeled on existing credit card systems. The premiums would be means-tested, so that the poorest received essential benefits at very low cost, while those with higher incomes would pay premiums on a sliding scale. All would use the card at the point of service, so no stigma would be attached to its use.
Some insurance plans for higher-income clients could offer full coverages at high premiums, while others would have co-pays and deductibles in return for lower premiums. Choosing to go to higher-priced primary medical care providers offering appointments and more experienced medical doctors would be a decision entirely in the patients' hands, with the additional incremental costs to be paid by the insurance company, a health-savings account, or by the patient directly through monthly billing.
This health-care system would not require any mandate, and would achieve nearly universal coverage, thus fulfilling one of the president's campaign promises. Virtually everyone would be expected to sign up for the medical benefits as an entirely voluntary act, because they are, in fact, benefits. The monthly premiums and coverage limitations for such a system would be set by competing insurance companies within very few and very broad guidelines.
In one simple stroke, the Trump Card would address health care, citizenship, and employment eligibility. Medical records would be linked to the card and maintained on the Internet by private-sector firms. Treatments and medications could easily be monitored for conflicts and overuse.
A profitable business model for the clinics would allow the marketplace to respond to changing demand. Incentives could be added to ensure presence in underserved areas. A competitive and flexible premium model would safeguard solvency.
Obviously, econometric modeling entities would need to run the numbers on this system, and the administration would need to manipulate the variables to bring the cost down to a tolerable level. Only then would they submit it to the Congressional Budget Office, which requires legislative language as the basis for its official estimates.
This simple concept is neither conservative nor liberal, neither purely private sector nor purely public sector. It should have broad and bipartisan appeal. And the whole thing would be the president's idea - disruptive and personally branded with his name. He can label it "terrific" and claim it's "much better than the disaster that is Obamacare." I can almost see his proud smile from here.