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“We were very close [on the health care bill]. It was a very, very tight margin. We had no Democrat support. We had no votes from the Democrats. They weren’t going to give us a single vote, so it’s a very difficult thing to do. I’ve been saying for the last year and a half that the best thing we can do, politically speaking, is let Obamacare explode. It is exploding right now…. It’s going to have a very bad year…. This year should be much worse for Obamacare…. We’ll end up with a truly great healthcare bill in the future, after this mess known as Obamacare explodes…. I know some of the Democrats, and they’re good people—I honestly believe the Democrats will come to us and say, look, let’s get together and get a great healthcare bill or plan that’s really great for the people of our country. And I think that’s going to happen.” —President Trump, press briefing March 24, 2017
Quite a curious piece of Trumpery, this ten-minute meeting prompted by the failure of the Republicans’ American Health Care Act (AHCA) to get enough support even to risk a vote in the House. This wasn’t President Trump’s health care plan—he’s never proposed a plan—but he’s still selling the possibility of a plan, bi-partisan at that, even if he has to allow—or cause—millions of people to suffer in the process, which implicitly involves his committing clearly impeachable offenses. Back to that in a moment.
First let’s wonder: why would anyone with a grasp on reality be surprised by the absence of Democratic support for eviscerating Obamacare? Obamacare was a rickety compromise with a Rube Goldberg structure trying to satisfy mutually exclusive goals, one of which was NOT universal health care coverage. But still it managed to insure some 20 million Americans who were previously without health care insurance. And Obamacare passed in the first place with no Republican votes! So why would Democrats, even the truly corrupt ones, vote to make a bad situation worse? No wonder President Trump quickly abandoned this argument untethered to any recognizable reality. He clearly acknowledged that, stating “Obamacare was rammed down everyone’s throats—100 per cent Democrat.” The president suggested that if Obamacare collapses as he predicts, that will pressure Democrats to seek a bi-partisan deal to the Republicans’ liking. As a candidate, Trump was selling a health care con, and that hasn’t changed.
“Obamacare is the law of the land,” House Speaker Paul Ryan acknowledged after his bill, the AHCA, was pulled before a vote.
Ryan had failed to get Obamacare repealed or replaced. That’s mostly because “repeal and replace” was always just an empty slogan. Passed by the House a zillion times in the past seven years, “repeal and replace” isn’t any kind of a plan no matter how loud you shout it. “Repeal and replace” may represent Republican seriousness and substance at its highest level, but even zealous Republicans can’t pass nothing into law.
Given that Obamacare is the law of the land, the president has a duty, an affirmative legal duty, to uphold that law unless and until it’s constitutionally changed. That’s the point of the president’s oath of office in Article II, Section 1 of the Constitution:
I do solemnly swear (or affirm) that I will faithfully execute the Office of President of the United States, and will to the best of my Ability, preserve, protect and defend the Constitution of the United States.
This is reinforced in Section 3, which enumerates many of the president’s other Constitutional duties, including: “he shall take Care that the Laws be faithfully executed.” [emphasis added]
So when President Trump tells the Washington Post, “The best thing politically is to let Obamacare explode,” he may be cynically correct, but he’s Constitutionally wrong. As president, Trump has no right to let Obamacare explode. He has a duty to faithfully execute Obamacare, which may prove easier than he hopes, since Obamacare may not be currently exploding so much as settling into a disappointing, low level stability.
At this point, no one knows what the Trump administration will or will not be willing to do to undermine the law of the land that it despises. Active measures by the White House could clearly be unconstitutional, but so could passive responses to Obamacare’s difficulties. The new Health and Human Services (HHS) secretary, Dr. Tom Price, a former self-dealing Congressman, is a devout Tea Party enemy of Obamacare and was a point man for its repeal. As HHS secretary, Price is responsible for managing Obamacare, obligated to do his best to make sure it doesn’t explode. But he is also in a position to make large and small decisions to undermine Obamacare by stealth and connivance. And what Price does or doesn’t do is all, ultimately, the president’s responsibility.
It’s hard to imagine that either the president and his secretary, with their vivid history of bad faith, will act honestly to make Obamacare work as well as possible. Perhaps they will be more or less correct in their prediction of an Obamacare explosion and clever enough to conceal whatever nefarious fingerprints they leave on the wreckage. What will Democrats do then?
The smartest, simplest answer for American health care that benefits the American people has long been in plain sight, and specifically rejected by President Obama in 2009, after campaigning on it in 2008. Senator Bernie Sanders has campaigned for it for decades, but it was specifically rejected by the Democratic leadership in 2016. Now the idea of single payer health care, also known as Medicare for All, is once more being dangled not only before Democrats, but before President Trump as the only way he can fulfill his grandiose campaign promises on health care. Senator Sanders, at a Vermont town hall style meeting with the other two members of the Vermont congressional delegation and an audience of about 1,000 people, said:
We have got to end the international disgrace of being the only major country on earth not to guarantee healthcare to all people as a right not a privilege. Within a couple of weeks I am going to be introducing legislation calling for a Medicare-for-All, single-payer program.
Over two months earlier, on January 24, 2017, Michigan’s Democratic congressman John Conyers introduced exactly such a bill in the House, HR 676—Expanded & Improved Medicare for All Act, that went unmentioned by Sanders, or even by Vermont’s Democratic congressman Peter Welch, who is one of the bill’s 72 current co-sponsors. As summarized by Congress.Gov, in part: “This bill establishes the Medicare for All Program to provide all individuals residing in the United States and U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care.” The bill is currently before four House committees, none of which have yet voted on it. Media coverage of the Sanders initiative often ignored the Conyers bill, as if Sanders were doing something new. On Democracy Now, Dr. Steffie Woolhandler summed up HR 676 and its long history:
HR 676, would be, you know, everyone just pays their taxes, and everyone is automatically eligible for a program like Medicare, only it would have no copayments, no deductibles for covered services, no participation by the private health insurance industry, so an expanded and improved Medicare, expanded to everyone, improved so it doesn’t have the kind of gaps in uncovered services that do—you know, do exist in the current Medicare program. We’ve been advocating that plan for decades. Frankly, Congressman Conyers and Senator Sanders have, as well.
Most of Washington’s “leadership” class is way behind the Democratic minority, and way behind the country on single payer health care—not least because it requires the constitutionally mandated general welfare of “we, the people” to take priority over the profits of insurance and drug companies. But maybe, out of opposition to Trump if not for better reasons, Democrats can unite around single payer. That would give them the policy high ground by supporting the medical consensus best choice for health care. And it would position them nicely as offering Trump a way, as he put it, to “work out a great healthcare bill for the people of this country,… a truly great healthcare bill in the future,… get a great healthcare bill or plan that’s really great for the people of our country. And I think that’s going to happen.”
The likelihood of that happening is probably increased by the threat of impeachment over failure to enforce Obamacare, assuming that Democrats have the courage to stand behind the Constitution. That should be made easier by the reality that President Trump has been impeachably in violation of the Constitution’s emoluments clause (Article I, Section 9) since the moment he took office. Democrats’ timidity to date is hardly reassuring, but perhaps they’ll be more motivated by the President’s weekly trips to promote Trump properties, or the cost of security for Trump family vacationers at Aspen, or the nepotism that puts un-elected millionaires like his daughter Ivanka in one White House office and his son-in-law Jared Kushner in another with apparent czar-like powers derived not from the Constitution nor the Congress, but only from his marriage to the president’s daughter. Presumably, at some point, already long overdue, Democrats (and even Republicans with respect for the Constitution) will find the courage and integrity to say enough is enough, but this is too much.
And if those impeachable offenses aren’t enough, maybe others will be, such as the resumption of US torture, kidnapping, and black sites—or the mountain of revelations about the conspiratorial nexus of agents of the Trump campaign with agents of the Russian power structure—or maybe just the stink of innocent dead victims of war crimes like the escalating slaughter of local civilians by American forces in Iraq, Syria, Yemen, and likely other defenseless places. There must be a limit. Mustn’t there?