The Orange Colossus has done it again.

He hasn’t just flipped the script in the Middle East – he’s turned two millennia of human history on its head. But more on that in a moment.

While a modicum of peace has broken out there, here at home, the government shutdown has come down to dueling – a better word might be “drooling” – sound bites.

Democrats: “Republicans shut down the government to take away your health care.”

Republicans: “Democrats shut down the government to give free health care to illegal aliens.”

Voters: “Shutdown? How about ‘shut up?’”

Yet amid the back-and-forth comes a purported sound bite that should perk up everyone’s ears. Recently ex-Politico flack Rachael Bade recounted an alleged Trumpian musing in a meeting with top Democrats:

“Nobody likes Obamacare. It’s expensive, bad coverage. What we should do is write a new health care program.”

Bingo: Once again, The Donald cuts straight to the actual impetus behind a standoff.

Because it’s dawning on Trump and his party posse that the real issue — Obamacare subsidies extended deep into the middle class during the pandemic but sunsetted under the One Big Beautiful Bill — creates a political time bomb.

To wit: The warning – and outright admission by leaders such as Harry Reid – that Obamacare was always intended as a way station to single-payer is inexorably coming to pass. As Sen. Ted Cruz predicted in 2013, the Democrats’ strategy – “to get as many Americans as possible hooked on the subsidies, addicted to the sugar” – is working better than anyone could have imagined.

The Democrats doubled down on that ploy with the expanded underwriting. Enrollment in Affordable Care Act “marketplaces” (an extraordinary double oxymoron) has doubled from 12 million to more than 24 million since then – not to mention the additional 20 million-plus benefiting from expanded Medicaid eligibility under the ACA.

And – yikes! – nearly nine in 10 of new enrollees were from 2024 Trump states. 

Yet the president is right: Obamacare and most “insurance” plans represent expensive, bad coverage, producing bad outcomes. 

The Obamacare subsidies not only conceal the true price tags but have shifted costs enormously. The Kaiser Family Foundation found employer health plan costs averaged nearly $26,000 last year, with workers contributing some $6,300. Meanwhile, without the subsidies, marketplace participants could see premiums more than double.

And all that money has resulted in worse outcomes. Kaiser also reports that nearly half of Americans struggle to meet costs – with 41% holding health care debt as of 2022. Thirty-six percent have put off needed care, and half of those say their health has worsened as a result. 

But two groups feel very healthy indeed: insurance companies and health care conglomerates. According to Brian Blase of the Paragon Health Institute, “In fiscal year 2023, federal subsidies through the ACA Medicaid expansion and the exchanges, which almost all flowed to insurers, totaled $218 billion. About half of all health care spending and the majority of health insurer revenue now comes directly from the government.” 

Why? An x.com influencer and self-described “health care technologist” – @shreehistory –quotes an anonymous former insurance official who maintained that the ACA’s Medical Loss Ratio rule (requiring 80% of premiums to be spent on care) “fundamentally changed (insurers’) business model. … Instead of trying to efficiently manage risk and costs, we learned it was more profitable to let costs rise and take our percentage. We became landlords collecting rent on every health care transaction.”

Moreover, consolidation of health care providers – a goal(!) of Obamacare’s architects –  is progressing rapidly. The Department of Health and Human Services says ownership of hospital beds by multi-hospital systems jumped from 58% of in 2000 to 81% in 2020, while the share of doctors in independent practices plummeted from 60% in 2012 to 47% in 2022.

This although a myriad of studies demonstrate that uncompetitive markets nail that everyday daily double: drive up costs while worsening quality of care. Whatta shock.

The good news? The president has now gone public, avowing that “some very good things could happen with respect to health care.” And when Donald J. Trump talks about such matters, to channel the old E.F. Hutton commercial, people should listen.

Exhibit A-Z: the Middle East accord. His third script-flip – the first two being the historic Abraham Accords and his initial Gaza reconstruction plan – appears to be bringing events to the logical conclusion: the hostages being freed soon, and Hamas on the way out, either willingly or at the edge of the sword. 

The terrorists finally came to the table because they were cornered. Trump managed to get the murderers’ Arab sponsors to co-endorse a “blank check” for Israel to finish the job if Hamas kept dithering.

Having succeeded there where no one thought it possible, Trump should go Kobayashi Maru on the Democrats, Obamacare and “Big Med.”

The outline of a solution: Just as the Orange Colossus brought disparate parties together around the basics of a Gaza solution – freed hostages, fried Hamas – he can suggest common ground on two health care fundamentals.

Small is beautiful. And power to the people … and providers.

How to get there: ditch Obamacare, Medicaid and employer plans. Institute a refundable, health care tax credit for a combination of capitated care with independent provider practices and true, catastrophic insurance – once called “hospitalization.”

The capped tax credit would cover all-you-can-eat preventive and basic care plans – much of which could be handled by physician assistants – for individuals or families. Want a jewel-encrusted “concierge” plan? Be our guest – on your own dime.

Voila! Take down the greedy big guys – whom the Democrats purport to hate anyway. Instantly free up trillions in middleman costs and diverted employee compensation. 

Re-empower small providers and patients – even, and especially – low-income patients chronically underserved by a fraud-ridden Medicaid establishment. They now join the rest of the population as “consumers” shopping for the best care and plan. 

Mr. Script-Flipper President, follow your instincts. As you did with Gaza, seize the opportunity to turn the current stalemate on its head for a bigger solution. Along with the higher ground – before your current ground is blown out from under you and your party.

Bob Maistros, a regular contributor to Issues & Insights, is a messaging and communications strategist, crisis specialist, and former political speechwriter. He can be reached at [email protected].

Views expressed by guest contributors to Issues & Insights are their own and don’t necessarily reflect the views of the I&I Editorial Board.

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