During the election campaign Donald Trump repeatedly claimed "I am a deal maker, I know how to make a deal". He also pledged that on the first day in office he would repeal the Obamacare and introduce a healthcare plan which would be "a lot less expensive, provide great healthcare and take care of everybody". Last Friday, March 24 his own party members in the House of Representatives, in no unambiguous language, declared their strong opposition to the plan that the House Speaker Paul Ryan drafted and President Trump endorsed. As the plan stood no chance of survival the Speaker, at the advice of the President, withdrew the bill at the eleventh hour from the Congress. Trump blamed the members of the Democratic Party for not extending support and said in exasperation, "let Obamacare explode".
Trump, beyond any doubt, was a successful deal maker. But his deal making in the past had different objectives and had different counterparts. His fundamental objectives were to extract maximum profits for his business conglomerate and his counterparts were commercial organisations, banks and property owners with whom he was at liberty to apply every tricks including bullying, bullshitting and coercing. But in governance, his counterparts include a powerful legislative branch, i.e., the Congress whose members are the elected representatives of the people. The members are not above bullying and enticements but ultimately they are accountable to the people. If they succumb to pressure be it from the President or the House Speaker and act seemingly against the interest of their electorates, they would run the risk of truncating their political careers.
The American Healthcare (AHC), as the proposed plan drafted by Ryan is called, appeared very clearly that it would not include everybody as Trump promised. In absence of the mechanism to keep the premium affordable to low-income groups, the Congressional Budget Office estimated that 14 million people would have been excluded from the health coverage by the end of the current year. The figure would have soared to 21 million in 2020 and 24 million in 2026. The Obamacare has made it mandatory for the business houses to provide health coverage to the employees but the proposed plan excoriated this provision leaving the low-income earners outside the coverage. People with pre-existing conditions have always been on the rough edge. Though the proposed plan prohibited the insurance companies against exclusion of people with pre-existing conditions it kept the premiums negotiable which would have placed the policy seekers at a disadvantageous position.
It became evident that the cuts to tax subsidies and halting the Medicaid expansion would leave many people uncovered in many states struggling with budget cuts. The conservatives favoured immediate suspension of the Medicaid that would save about $880 billion from now untill 2020 while another group demanded converting the programme into a fixed payment to the states which would then use the money to support healthcare for the poor residents. The members in the Congress realised that public opinion was rapidly shifting against the proposed plan. A recent poll suggested that 56 per cent voters opposed the draft plan as against 17 per cent in favour; 26 per cent were undecided.
The Association of Doctors, the insurance companies and the pharmaceutical companies voiced concerns on large number of people leaving outside the health coverage. The members of the House of Representatives could not have ignored the ground situation. Consequently, in defiance of Trump's carrot and stick approach, a large number of Republican members decided to vote against the proposed plan making it certain that it would be rejected by the House. Trump in deep humiliation withdrew the bill from the House.
Trump, by abrogating the Obamacare through the Executive Order, has set in motion instability in the healthcare system. The insurance companies gradually withdrew from the Obamacare and in many states the costs of premium have soared significantly. The increased costs of premiums have forced many policy holders to surrender the Obamacare. By abrogating the Obamacare and failing to put in place a new plan the Trump administration placed the entire healthcare system in jeopardy.
While the proposed plan was being discussed and members from the Republican Party were raising demands for fundamental changes, Trump admitted that the healthcare system is very complicated. His belated realisation about the complexity of the system, however, did not make him alter the trajectory. Some of his advisers from the inner circle acknowledged that despite shortcomings, the Obamacare was able to enroll 21 million people who had no prior insurance coverage. The number of uninsured population was reduced by almost 50 per cent in 2016.
Trump never made a serious attempt to reach out to the Democrats. Instead, he went on vilifying the previous administration for introducing the Obamacare which he termed as a "disaster". His strategy to bulldoze legislation by numerical strength of the Republicans fell flat when more than 25 members of his own party vowed to oppose it. Had he known the art of political deal making he would have embraced the moderates amongst the Democrats and navigated the legislation. Trump failed because of arrogance and ignorance.
It will be irresponsible on the part of the Trump administration to wait for the Obamacare to explode. That will cause a chaos in the healthcare system and millions will suffer. The people will only blame the government. The White House must admit that despite shortcomings, the Obamacare was working and the problems that arose during the last eighteen months are not beyond repair. These can be fixed with administrative intervention. Now that the attempt to replace Obamacare has failed it would be prudent to restructure a health plan on the framework of the Obamacare.
The "deconstruction drive" of the White House hasn't yet produced any dividends for the government. The travel ban rejected by the court has been revised but now hangs in the court. The 'beautiful' wall in the southern border is now being considered to be built with taxpayer's money after Mexico refused to pay for it. The Trans-Pacific Partnership Agreement has been abrogated but the member-countries have reportedly invited China to join the trading bloc. Trump's claim of wiretapping of Trump Tower by his predecessor has been dismissed by his own party members. Many of his top advisers are being accused of having clandestine ties with Russian government since mid-2016 and they are now under investigation by the FBI. Trump's approval rate has dipped below 35 per cent. Given all these setbacks, he should now take a pause and try to realise what has gone wrong.
The writer is a former official of the United Nations.