There is only one sure thing when it comes to predicting what President Donnie will do. He’ll always do what he thinks will serve his interests. It might not actually serve his interests, but he will believe it does. Otherwise he wouldn’t do it. That’s because he doesn’t have an altruistic gene or self-sacrificing neural pathway in his body. Not one. He is 100% self-centered and selfish. 

The possibly good news is that Donnie has promised not to cut Medicare and Medicaid (and Social Security):

Plus, there’s this:

…T***p told the Wall Street Journal he would consider keeping two of [the ACA’s] most popular provisions — one that allows adult children to stay on their parents’ health insurance plans, and another that would forbid insurance companies from refusing to cover “pre-existing conditions.”

“I like those very much,” the newspaper quoted Trump as saying [on Nov. 11th].

Furthermore, although he has parroted the standard Republican line about quickly repealing the Affordable Care Act, he’s said it should immediately be replaced with something “terrific”. In his case, of course, “terrific” usually means either expensive or fraudulent, but let’s assume he wants the ACA replacement to be popular. It’s true that he’s so mendacious, ignorant and/or stupid that he recently said it will take about a week to design and approve a terrific replacement, but put that aside too. Perhaps he sees an opportunity to feed his narcissism by doing something that will make most of America admire him (as unlikely as that will ever be). 

It shouldn’t have been a surprise, therefore, that Donnie told “The Washington Post” yesterday that he will shortly unveil a plan that offers “insurance for everybody”!

(By the way, before I forget, whoever is responsible for childishly defacing that picture up there from Donnie’s Twitter account is going to be in big, big trouble on January 20th.)

Of course, given that the President-elect’s entire career outside reality TV has been based on telling suckers what they want to hear, his promises are less than worthless. But at least we know that protecting Medicare and Medicaid; limiting the ruthlessness of insurance companies; and making sure we all have health insurance are ideas he’s heard of.

There are a few other reasons for a tiny bit of extremely cautious optimism:

(1) Most of us don’t want the ACA repealed and nobody wants to lose what they already have, so there has been a huge negative response to the Republican “plans”, with websites like Faces of the ACA , articles like “Without Obamacare, I’ll Get Sicker, Faster, Until I Die” and “Here’s What One Cancer Survivor Wants You To Know About Obamacare” and constant reminders that it’s “Time to Turn Up the Heat: Senate Staffers Are Complaining About the Avalanche of Angry Calls”. The anti-ACA repeal movement is also getting support (some of it lukewarm) from unlikely sources, including Republican governors, hospital administrators, insurance companies and the American Medical Association. 

(2) The House of Representatives almost always follows its leader, the odious Paul Ryan, but the Senate is much less predictable. Even in the House, the most reactionary Republicans sometimes vote against their leader because a proposed piece of legislation doesn’t harm enough people. In fact, recent history shows that Republicans find it much easier to agree on what they’re against than on what they’re for. On top of that, nobody knows how  Pres. Donnie will react to legislation that doesn’t obviously satisfy his greed or narcissism. For a helpful summary of the procedural hurdles Congressional Republicans are up against, see “Everything Republicans Will Have To Do To Actually Repeal and Replace Obamacare” (subtitle: “It Won’t Be Easy”). 

(3) It’s been reported that there is more opposition to “Obamacare” than to the Affordable Care Act. The more people learn what the ACA actually does, the more they like it. So, once President Obama becomes a fond memory, and despite well-funded Republican efforts to confuse the issue, it’s possible that support for the ACA will increase. Andy Slavitt, the acting administrator of the Centers for Medicare and Medicaid Services, prepared a list of everyone who will be negatively affected by repeal of the ACA (without, of course, a terrific replacement):

And let’s not forget this bit of good news:

Will spreading the good news about the ACA and bad news about its repeal have an effect on the right-wing ideologues in Congress and the orange person in the White House? We don’t know, but it’s worth a try.

One last thought for now. One of the phrases that comes up in arguments about our healthcare system is “socialized medicine”. It’s used to attack the idea that the government should control or bear responsibility for healthcare. When you think about it, however, it’s clear that healthcare does have a very strong social aspect. If we don’t want poor people dying in the streets or dread diseases spreading through the population, we need society, including the government, to make sure people get medical treatment. This is why people who arrive at emergency rooms at the edge of death get medical treatment, even if they don’t have a health insurance card or a suitcase full of cash.

The idea that healthcare is a social good fits nicely with the standard Democratic view that “we are all in this together”. Most of us don’t want to live in a dog eat dog world. 

Republicans, however, lean toward the “every man for himself” or “not my brother’s keeper” model. That’s not all bad. Almost everyone puts themselves, their family and their friends ahead of strangers. But in the Republicans’ case, that fundamental attitude easily translates into less for the poor and sick and more for the rich and healthy. That’s the underlying message behind Paul Ryan’s recent statement that he favors “high risk pools” for people with “pre-existing conditions”. He was answering a question from a cancer patient whose life was saved by the ACA:

So we, obviously, want to have a system where they can get affordable coverage without going bankrupt because they get sick. But, we can do that without destroying the rest of the healthcare system for everybody else. That’s the point I’m trying to make. What we should have done was fix what was broken in health care without breaking what was working in healthcare, and that’s what, unfortunately, Obamacare did. So, by financing state high-risk pools to guarantee people get affordable coverage when they have a pre-existing condition, like yourself, what you’re doing is, you’re dramatically lowering the price of insurance for everybody else [PoliticsUSA].

Doing this won’t work, of course, unless those unlucky sick people are wealthy enough to pay sky-high premiums, the government (meaning the rest of us) pays their bills or they simply give up, drop out of the insurance market and take their chances. That’s how “high risk pools”, also known as “insurance ghettos”, have always worked, i.e. failed, in the past.

A closing comment from the PoliticsUSA site:

… Ryan thinks cancer patients and other pre-existing conditions are ruining healthcare for everyone else…The true evil in [Ryan’s] plan is that by separating out the high-risk patients from everyone else, Ryan … can keep costs down by underfunding the pool for people who need healthcare the most…

That’s the attitude we’re up against. The news isn’t all bad, but it’s not going to be easy.