Shortly after Tuesday’s shellacking became apparent, Donald Trump told mainstream media reporters that he accepted the election’s results and hoped to work with Democrats after they take over Congress in January. Yet, a few moments later, he went on Fox News to promise the GOP’s MAGA base that he will reject any “insane” bill the new majority party sends to his desk.
“I have the power of veto and the power of veto is impervious,” he said.
I predict that over the next two years the lame-duck president will continue to cater to his shrinking base and not make a last-ditch effort to reverse his well-deserved reputation as one of the worst presidents in American history. After all, he remains someone who suffers from narcissistic personality disorder*; someone who operates on the principles he learned at the knee of his mentor Roy Cohn: Never admit defeat, never apologize, and always attack your critics.
*The Merck Manual definition of NPD:
Narcissistic personality disorder is characterized by a pervasive pattern of grandiosity, need for adulation, and lack of empathy … Patients with narcissistic personality disorder have difficulty regulating self-esteem and thus need praise and affiliations with special people or institutions; they also tend to devalue other people so that they can maintain a sense of superiority.
When it comes to health care—the issue that voters repeatedly told pollsters was either their first or second most pressing economic concern ahead of the mid-term election—there’s little chance that Trump will sign federal legislation that will finally provide every American with comprehensive health insurance coverage at a price they can afford, fix our broken delivery system, and gradually bring its overall cost down to international norms.
And let’s face facts: The Democratic Party is divided on the best way to achieve those goals. There is growing support for establishing a single payer for health care, or Medicare for All as it was popularized by Sen. Bernie Sanders of Vermont. The M4A caucus will have an articulate new champion in the Senate, Dr. Abdul El-Sayed from Michigan. The former health commissioner overcame vicious Islamophobic attacks by both his opponent and the president to hold onto that seat for the Democrats.
But more centrist members of the party, probably a majority of the Democratic caucuses in both chambers, continue to back incremental reforms. Those with long memories recall how the insurance industry launched massive advertising campaigns to stoke fears among the 180 million people with employment-based coverage that they will “lose what you have.”
Their most far-reaching proposal is creation of a government-run public option on the Affordable Care Act exchanges that can be purchased not just by individuals and families without coverage, but by employers willing to abandon providing the benefit. The incrementalist faction will put forward a host of other reforms, like capping out-of-pocket expenses, limiting prior authorization, reining in drug prices, and busting up hospital, pharmacy, and insurer monopolies.
Since there’s little chance either faction will be able to pass anything of significance over Trump’s veto, this debate will continue right through the 2028 Democratic primaries. And that’s how it should be. Let the party’s voters decide what approach they’d like to see their next presidential standard bearer champion.
Voters want help now.
But that leaves Democrats vulnerable to losing support among voters who backed change on Tuesday not just because they hated Trump, his flagrant disregard for the rule of law, his corruption, his war in Iran, and his inhumane attacks on immigrants, but because they want a government that actually helps them with their daily economic struggles. Health care costs are at or near the top of their list. Isn’t there something Democrats can do next year at the national level, either administratively or by passing a law that Trump would sign, that can provide immediate relief?
That’s the question I posed on Monday to an expert panel at the annual meeting of the American Public Health Association in San Antonio. The topic, appropriate for the day before an historic election, was: “What next in the quest for universal coverage.” “If Democrats win both houses, yet Trump still wields a veto pen, what would you recommend that the new majority leaders of the House and Senate pursue as a health care affordability agenda over the next two years?”
Participants included Chiquita Brooks-LaSure, the former administrator of Centers for Medicare & Medicaid Services during the Biden administration; Dr. Claudia Fegan, a former president of Physicians for a National Health Plan, the long-time advocacy group for Medicare for All; Harvard professor John McDonough, whose new book, America’s Wrong Turn, documents how health care is undermined by profit-driven medicine; Tsung-Mei Cheng, a health care policy analyst at Princeton University who advised Taiwan during its adoption of a single-payer system; and Nadine Garcia, the CEO of Trust for America’s Health, the nation’s leading advocacy group for more funding for public health.
Suffice it to say, their answers reflected both factions within the party, with most advocating an incrementalist approach. Restore the ACA subsidies for people earning up to 400% of poverty; restore the Medicaid cuts; push the 10 states that failed to expand Medicaid to do so; restrict use of prior authorization; expand drug price negotiations; and more.
Given the power of the medical industrial complex to thwart more far-reaching proposals, McDonough threw campaign finance reform into the mix. Only Fegan of PNHP, the single-payer advocacy group, said Democrats must go beyond the ACA, which, even during the Biden years with its expanded subsidies, never achieved universal coverage (see chart above).
To my great disappointment, no one on the panel highlighted doing something for people with employer-based coverage, who are also being crushed by skyrocketing premiums, deductibles, and co-pays. They also failed to offer anything for the millions of people burdened by unaffordable medical debt. No one recommended passing a federal insurance regulation that sets a percentage-of-income cap on what any household can pay for health care each year, something I’ve been advocating for in GoozNews.
I came away thinking: Yes, the new majorities in the House and Senate need to do everything in their power to reverse the draconian cuts imposed by the Trump II regime and the GOP-run Congress over the past two years, which has sent the uninsured rate soaring. But they also need to put laws on the president’s desk that will provide some relief for those who are already insured and face a huge health care cost problem.
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