When President-elect Trump announced he would, in a few days, force Congress to enact comprehensive health insurance for everyone, poor or rich, that would provide better and cheaper care than they've ever gotten, you had to wonder whether this guy is a miracle worker or a fool.
A third posit is that he is just another politician, a supplicant who makes promises that he doesn't expect to deliver. But most Americans, admirers and enemies alike of the old billionaire TV idol, don't count Trump as just another politician. Even at their lowest, politicians are clinical pragmatists. Pragmatists don't promise to instantly reshape global relationships, end Middle Eastern terrorism, make government efficient, get the economy roaring so everyone has a great job with a good income, build a giant wall across the continent at no cost to taxpayers and either co-opt the country's enemies into friendship or smash them. And, now, fulfill the dream of presidents since Theodore Roosevelt to deliver great medical care, as a right, to every American.
So it's time to examine the first two options, although inaugural week is not the best time frame. Health insurance is the perfect model for the study because Trump promised to get it done in the first days of the new Republican government.
In an interview with the Washington Post, Trump returned to his seminal policy stand, universal health insurance, although this time he said it would not be a single-payer system like Medicare but, like Obamacare, an expansion of the private insurance market. During the campaign, he said Obamacare would be repealed, but he stumbled around on its replacement by mentioning some empty Republican ideas like peddling insurance across state lines. Republican leaders have talked about just assuring "access" to insurance and care, not seeing that people had a way to pay for it.
No, Trump said, his secret plan sees to it that the poorest person can pay for it and that the policies will provide wider coverage with much lower premiums, deductibles and copays, the chief complaint about Obamacare.
"We're going to have insurance for everybody," he said. Alluding to the prevailing Republican philosophy, he added: "There was a philosophy in some circles that if you can't pay for it, you don't get it. That's not going to happen with us." Under Trumpcare, people "can expect to have great health care ... in a much simplified form — much less expensive and much better."
Obamacare has insured 20 million more Americans, leaving only 9 percent of U.S. citizens uninsured. Trumpcare would pick up that 9 percent.
But that is a mathematical and fiscal impossibility unless it does one of two things. Either the government subsidizes private insurance coverage with hundreds of billions of dollars, which Obamacare would achieve with the same remedy, or it imposes by law draconian price ceilings on doctors, hospitals, drugs and insurers. Talk about government strangling the free market. You couldn't get that done even with an overwhelmingly Democratic Congress. And if the Republicans are dedicated to one principle, it is to slash, not raise, domestic spending.
But Trump said Congress will be no barrier and its leaders are on board with his plan. It will pass within days, maybe even the same hour that the Affordable Care Act is repealed, he said. He has insisted, as have many congressional Republicans, that the current law will not be repealed until a good replacement that covers those 20 million is pretty well in place.
That brings us to the second explanation, which is that Donald Trump is clueless about how government works. He provided ample evidence on almost every issue that has arisen. He never evinced any knowledge of the Affordable Care Act, except that the plans had high premiums, deductibles or copays. Except to hire a cagey tax lawyer to evade income taxes for most of his life and pleading with Congress once to restore the tax break for developers that Ronald Reagan took away in 1986, Trump never had a direct involvement in government at any level, which was part of his appeal. We are about to see the downside of that naivete and we will be fortunate if it is not calamitous.
For Trump, there is a fourth caveat, which his campaign and transition aides invoke every day: Don't take what he says literally. Things that are not true or simply absurd are not really lies as we know them but only talking points, opening bids, playful rhetoric or just jokes that sound serious to people who aren't on his wavelength.
The likeliest scenario is that Congress will repeal Obamacare, some of it like the individual mandate and taxes on millionaires to occur immediately, which will undermine the market and send it crashing in 2018, so the millions deprived of insurance coverage can blame the black man and not Congress and the president that did not produce the coverage he promised.
For the moment, let's pray for the miracle-man outcome.