Trump Withdraws From The Paris Agreement; Keeps Embassy In Tel Aviv

Yesterday, in typical deal-making mode, President Trump made two major decisions, one certain to please conservatives and the other just as certain to assuage liberals. He announced that the United States would withdraw from the Paris climate agreement, negotiated by the Obama administration in 2015; and, earlier in the day, signed a waiver that kept the American embassy in Israel in Tel Aviv, rather than moving it to the Israeli capital in Jerusalem, as he had promised repeatedly during the presidential campaign.

So, one promise kept, another broken. Sounds like a typical day in the presidency of Donald Trump.

I agree with the conservative conventional wisdom that the Paris agreement was a bad deal for the country, and that the embassy should move to Jerusalem immediately. Persuasive arguments for both positions are fairly easy to find, and I won’t rehash them now. But what I find interesting is that the announcements of both decisions occurred on the same day, fitting what has become a pattern for this administration: bad news is regularly paired with good, or, more specifically, the announcement of one policy guaranteed to find favor with those on the Right is always paired with the announcement of another guaranteed to unsettle conservatives.

In general, this isn’t an unusual strategy in politics, or for that matter in any business involved in public relations. But I find it interesting how closely the Trump administration has been keeping to this form of one good thing for the Right, coupled with one bad. Before the Paris withdrawal and the keeping of the embassy in Tel Aviv, it was the (good) federal budget blueprint, coupled with the (bad) push for the American Health Care Act. The pattern even dates back to Trump’s cabinet announcements from the transition period, where one pick that might be greeted unenthusiastically by many Republicans was often announced alongside another guaranteed to excite the base. And there have been many other examples of the same basic pattern over the course of the Trump presidency to date.

So the next time the administration makes an announcement that is cause for celebration, wait to see what the bad news is going to be. Conversely, if there is an announcement of a policy conservatives are guaranteed to disagree with, expect some good news to emerge soon after. On this, at least, the Trump White House seems to operate like clockwork.

A Repeal and Replace Plan That Works

For more than six years, the one constant in every single Republican campaign was a promise to repeal Obamacare. Presidential candidates said it. Prospective senators and congressmen said it. Gubernatorial candidates, too, said that if elected they would do everything in their power to fight the Affordable Care Act’s many encroachments on state power. Given the chance, even Republican mayors and county councilmen would loudly proclaim how opposed they were to Obama’s signature legislative achievement.

In return, Republicans were given the House in 2010. They were given the Senate in 2014, and, against all odds, the White House in 2016. And what do they do with their newfound power to finally repeal and replace Obamacare, a day many believed would never come?

They introduce the American Health Care Act, a bill whose first sentence begins, “the Patient Protection and Affordable Care Act… is amended.” A fitting summary of the contents of the bill.

The individual mandate is repealed—and replaced with a new mandate, a requirement for insurance companies to charge extra those who allow their insurance to lapse. Such a measure is just more government overreach, and of doubtful constitutionality.

Medicaid is reformed—but not until 2020. And those reforms are clumsy and unnecessarily complicated, far short of the simple block grant program that many have argued for.

Some taxes are repealed—but others are kept, including the ridiculous Cadillac tax on “deluxe” health plans.

And the Independent Payment Advisory Boards, or “death panels”, remain in place.

Without a doubt, this is better than the current Obamacare framework. But it should not be enough for Congress to merely pass a bill where the best thing that can be said about it is that it is better than a disaster. We can and must do better.

The first step should be to repeal Obamacare outright. Ideally, this would consist of a one-sentence bill: “The Patient Protection and Affordable Care Act is hereby repealed.” Unfortunately, such a bill would have been feasible only in the early years following the ACA’s initial passage. Measures have already been implemented that cannot be easily taken away without disrupting the lives of millions.

Instead, Congress can merely repeal the individual and employer mandates, taxes, and all other assorted regulations, along with halting all further Medicaid expansion. Repeal, too, the requirement that insurance companies must allow young adults to stay on their parents’ plans until age 26. Whether there would be some kind of staggered end to this provision, or a grandfather clause, could be up for discussion and debate.

Don’t worry about anything else in the repeal legislation. Stop Medicaid expansion, but don’t reform the program just yet. Don’t worry about the familiar cries of “But what will you replace it with?” The American health care system circa 2009 may not have been ideal, but there weren’t hordes of starving people dying in the streets. And the gap between the end of Obamacare and the beginning of a new kind of health care system need not be long, because Republicans could already be working on a replacement while the repeal bill was passed and implemented.

That replacement bill, that vision of a new health care system, would be radically different from both Obamacare and House leadership’s own proposal. It would put the marketplace and the individual first by offering true choice and competition, and eliminating all government mandates. It would dramatically expand Health Savings Accounts, far more than the AHCA proposes, and allow insurance companies to compete across state lines. It would address badly-needed tort reform head on. All of these are classical GOP beliefs on health care policy that, somewhat surprisingly, get little mention in the tepid proposal put forth by Congressional leadership.

Yes, Speaker Ryan and the rest say that additional legislation will be forthcoming, once the AHCA has been passed. But given the milquetoast nature of that proposal, coupled with leadership’s long history of proclaiming their intent to “fight another day”, how likely does it seem that radical health care reform legislation is imminent?

Because that is exactly what we need: radical reform. Reform that places individual choice, not government coercion, at the forefront of the health care policy debate. Accordingly, the American Health Care Act should represent the opening salvo of negotiations, not a final product.