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December 19, 2018

Reindeer Games

Christmas is on final approach, so I am going to invite you to channel your inner child, the one from so many years ago who was really banking on this Santa guy to come through. Oh, come on…pretend for just a minute.

In Monday’s post about the court decision to invalidate the Affordable Care Act, we noted the President’s tweet to the 2019 Congressional leaders: ‘Mitch and Nancy, get it done!’

That got us digging back through the What Matters archives.  Sure enough, there on August 19, 2016 we wrote about this magical possibility of President Clinton and Speaker Ryan setting aside their political differences and hammering out a more viable health care policy.

Oops, I totally missed the election of President Trump, which is why I stay out of the prediction business.

But at the time, the thinking among some Washington insiders was that she would need to save Obamacare from itself and shore up some of the fundamental flaws; he would like changes that would mitigate coming fiscal and deficit risk; that might be just enough to lead to cooperation.

Now we fast forward to reality and a time when the idea of cooperation seems even further fetched that a rather large chimney sweep with a penchant for red velvet and flying sleighs.  But in the spirit of the holidays, allow me to ponder a similarly wild scenario for elves Trump, Pelosi and McConnell.

First, we know the Big Elf is fundamentally a deal maker, more than a policy purist.  And getting a deal done with people he has previously insulted (see Canada, maybe China) seems to bring a special joy.  Did you see the Trump, Pelosi, Schumer spat the other day?  Just saying.

Trump and the Republicans know that if the ACA is officially killed on appeal by the Supreme Court, they then own the whole issue, including finding a way to make the ban on preexisting conditions work economically for everyone.  That will be a trick.  Cutting a deal with Nancy to share that ownership might not be all bad.

McConnell has to be thinking about having this conversation in 2021 with Pelosi and President Biden/Sanders/TBD.  Having another Republican, even an unpredictable one, at the table now might not be all bad.

The real wildcard would seem to be Pelosi.  Do the Democrats have enough to gain to work on it now with Trump?  Can they really work on something this big with someone they are trying to impeach? Do they just wait for the inevitable control of the White House, just as it was in 2016…oh wait…that didn’t quite work out, did it?  Negotiating with Trump, who might really need a deal if that China thing doesn’t work out, might not be all bad.

Yes, I am hearing hoof beats on the roof.

Tim Coan
Tim Coan

CEO and founder

Tim Coan, ALN’s CEO, writes an insightful and witty blog weekly about a variety of topics relevant to independent physician practices.