Here’s an idea-so-crazy for a big, Trump-like move on health care of the sort Peggy Noonan seems to call for: Lower the Medicare eligibility age to 55 (from 65) as part of the deal. Why?
1) This would remove the costliest, highest risk cohort (older people) from the Obamacare risk pool, allowing Obamacare insurerers to lower prices. The near-poor who are served by the program would find it easier to afford. Ditto the healthy young. The unsubsidized middle class would feel less ripped off.
2) The deal could still include many things Republicans want:--e.g. replacing the individual mandate with some other incentive, offering tax credits instead of subsidies, paring down the list of “essential benefits” (that anyone who buys an Obamacare policy must purchase–including substance abuse treatment), eliminating the rightly controversial Independent Payment Advisory Board. Or bolder: Make selling Obamacare insurance a nationwide market (rather than in 50 state markets),
3) Medicare-at-55 wouldn’t just be a halfway house on the way to Bernie-style Medicare-for-everybody. It’d be a way to give the competitive Romneycare/Obamacare model a chance to work. It’s not working now. We could decide later whether to apply it to Medicare or expand Medicare to absorb it. Let the best model win.
4) It would add to the federal budget. (Medicare isn’t cheap.) Since when has Trump been Dr. Cut-the-Deficit-Now?
5) How would it pass? Straight down the middle. Medicare-at-55 will be very popular with voters, including Trump supporters. That’s a big engine to power any deal through (just as voter hostility to welfare powered the 1996 welfare reform through, in another down-the middle play). Democrats (and many Republicans) would have a hard time voting against a deal that included Medicare-at-55. In the 1996 welfare debate, President Clinton was a passive triangulator, oppposing, but not actively denouncing, the pro-welfare views of his own party in Congress. You’d expect Trump to be far less passive dealing with recalcitrant GOPs who don’t get on board. Arguably that’s what voters expected when they elected him.
Just a thought!