Thursday, July 20, 2017


By Dominique Paul Noth

For eight years, Republicans of every political stripe have made it their mantra that the ACA (Obamacare) must be repealed and replaced.  Now political realities suggest a clear fix – apologize for being wrong for eight years and move to repair the stuff both sides agree need adjustment.

Standing in the way of an apology that most Americans would welcome is a president whose whole reputation is built on non-apology. 
Photoshop gremlins had fun on Facebook melding Trump with his
doctor but actuallly there is an easy health care solution -- admit
a mistake and move on.

Donald Trump has made a career of refusing to back down from whatever nonsense escapes his speeches or tweet threads, such as forming commissions to investigate nonexistent voter fraud, or continuing to challenge Obama policies he is actually building on because they work. His ability to find grievances in every event has become legendary even as he mangles history and facts as he did for New York Times.

It’s not quite like Ted Cruz admitting the GOP would look foolish backing away from repeal and replace -- though "foolish" looks like a tiny problem in the current state of things.

Trump is now insisting it was THEIR promise, not his. In fact, he will sign ANY bill they put in front of him. 

The   repeal-replace rhetoric was absurd with Obama in office and it remains a bigger absurdity today as the ACA has taken hold and helped far more Americans than claim damage despite the drumbeat of GOP ads.

Now Trump is assuring Congress that he won’t even read what they give him to sign!  This is his last gasp. 

He doesn’t know or can’t say that 85% of the people on the health exchanges have subsidies to help them with their premiums and that most of the complaints are coming from people just on the other income side of the subsidies. The exchanges are also a miniscule part of the ACA and get better fast if insurance companies are reassured by the president that the underwriting will continue, as now it should by law.

He apparently doesn’t know that most people in the ACA rely on employee health plans where their companies are supposed to have negotiating power on premiums or that Medicaid alone pays for 49% of the babies born in this country. Some 74.5 million individuals were enrolled in Medicaid and CHIP in April -- yes, those are government programs.

Some Republicans actually seem ready to admit repeal-replace was a lousy pledge, but now a day after suggesting repeal without replace would work, Trump doubled down July 19, suggesting a simple White House meeting with “I’m the greatest deal closer” could fix both repeal and replace.

The world had changed around him.  Evidence exists that Obamacare is not failing – it is being sabotaged.  Health insurance companies simply want Trump’s promise that the ACA subsidies will continue, so success is in his small hands.

The president clearly doesn’t understand health care policy and actually wants to keep several things the Obama bill made possible – pre-existing coverage, children on parental plans until age 26, etc.  He doesn’t even understand that every version of the GOP bills he never read happily offers one form of subsidy or another (that’s actually one of the right wing’s problems).  

There’s a giant duplicity in the Republican talking points – that people don’t want to be forced to buy insurance if they feel, today at least, they don’t need it, but that’s only because they know others in society are poised to pay for their emergency room visits.

Health insurance works when the pool includes those who need it now and those who may need it in the future.  Plus there are terrific rewards from preventive care.  These are the larger universal truths about the American experience that comes through in war and peace – Work together to support each other, and recognize that sometimes we need government to help us do that.

There is a philosophical issue at work as well -- being mandated to be covered, as in everyone pays something. People understand that with state auto insurance, Social Security and income taxes, but some draw the line on health care.  It sounds so American to say citizens shouldn’t be forced into participation by government -- except it is also anti-American to not recognize there have always been exceptions.

The central dilemma in the discussion remains whether health care is a right or a privilege. The Republicans seem to be saying that anything we have to pay for is not a right, conveniently forgetting the military, the highways and even the breadth of Medicaid.  

This is also an underlying misconception on the left, which thinks terms like “single payer” or “Medicare for all” don’t carry a price tag.  They do and these systems will be much harder to set up in a nation that has built its health care system around private companies.  Obama recognized that as he moved the “right not a privilege” argument forward but maintained the private companies and their high level of employees and affiliates (one sixth of the economy) through a remarkably sturdy system of levers, sticks, sweeteners and counter-weights.

The Republicans, after eight years of empty flailing, are only now realizing how carefully the system was built.

Since none voted for it, they conveniently forget how many Republican ideas were incorporated, inviting GOP votes that never came (here is where my memory differs from GOP Sen. Susan Collins, who thinks the Republicans weren’t asked and now  rightly wants any new system to have both parties cooperating – but so did Obama).

Even Obama’s universal lie of 2013 (if you like your plan and your doctor, you can keep them) was a poorly worded anticipation that doctors would not flee good plans and providers would fix bad ones. 

His public relations optimism did not anticipate court roadblocks, a medical community both noble in some practices but also venal and guilty in the opioid epidemic, the financial games health companies and big pharma are experts in, the refusal of half the states to participate in the health exchanges, the reluctance of so many states to expand Medicaid despite the financial incentives, and so forth. 

Only now after eight years has the American public on the left and right realized that cooperation and repair are the best path forward – not continuing to insist on a pledge that was not thought through to begin with.

The current president, who keeps trying to shame the Republicans with their stupid pledge he apparently never agreed to, has laid down the biggest blockade to improving health care.  He thinks a few words over a White House lunch will convince the Republicans.

Minnesota Democratic Sen. Amy Klobuchar disagrees, referring to the three Republican senators who have spoken out against the meanness of the GOP bill in its various forms – Lisa Murkowski, Shelley Moore Capito and Collins.

Said Klobuchar: “I don’t think a tuna salad sandwich is going to change the minds of these three strong women” – who incidentally were excluded from the original white male taskforce on the Senate bill.

About the author:  Noth has been  a professional journalist since the 1960s, first as national, international and local news copy editor at The Milwaukee Journal, then as an editor for its original Green Sheet, also  for almost two decades the paper’s film and drama critic. He also created its Friday Weekend section and ran Sunday TV Screen magazine and Lively Arts as he became the newspaper’s senior feature editor. He was tapped by the publishers of the combining Milwaukee Journal Sentinel for special projects and as first online news producer before voluntarily departing in the mid-1990s to run online news seminars and write on public affairs and Internet and consumer news. From 2002 to 2013 he ran the Milwaukee Labor Press as editor. It served as the Midwest’s largest home-delivered labor newspaper, with archives at  In that role he won top awards yearly until the paper stopped publishing in 2013. His investigative pieces and extensive commentaries are now published by several news outlets as well as his culture and politics outlets known as Dom's Domain.  His award-winning theater reviews appear at


  1. Dump Obamacare it is disaster by the Left and give money to states they can use it better.

  2. Home healthcare should be the focus. I hope every politicians take this seriously.

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