EDITORIAL: No deal for the dealmaker

March 26--Remember when Republicans said Barack Obama could have gotten so much more done if he'd been a little more sociable, a little more willing to coax and cajole GOP lawmakers into working with him?

Well. Donald Trump, the famed private-sector dealmaker, author of "The Art of the Deal," brought them to the White House by the dozens and visited Capitol Hill himself. He took part in more than 120 phone calls and one-on-one conversations, according to the White House. And even he, a Republican president, couldn't get enough GOP support to get a key priority -- repealing Obamacare -- through the Republican-controlled House of Representatives.

This is truly a remarkable story. After seven years of condemning the Affordable Care Act, Obama's signature achievement in health care, and a 2016 campaign full of promises to repeal it, Republicans finally took control of the government and had absolutely no idea what to do.

"This is a setback, no two ways about it," House Speaker Paul Ryan acknowledged forthrightly on Friday after recommending to the president that they pull the bill rather than watch it go down to ignominious defeat on the House floor. "We're going to be living with Obamacare for the foreseeable future."

There are a number of GOP legislative priorities that make sense if you believe in conservative principles. Tax reform, for example. Immigration reform, for another. Unfortunately for the Republicans, health care is not one of them.

There is no feasible "free market" health-care system for people of modest means anymore. The costs of health care in the technological age are simply too high for all but the wealthiest families to afford. Once you convert the financial foundation of health care into the concept of insurance, whether that insurance is underwritten by the private or public sector, you have "socialized" health care, you have attempted to spread the risks across a broad swath of the population so that expensive treatments for sick people are subsidized by the premiums of healthy people.

Many Republicans seemed sincerely not to understand this basic concept of insurance. More than one older male Republican went on TV to declare he didn't need maternity care and didn't want to pay for it. The fact that the young woman who might make use of this care would also be subsidizing prostate cancer care with her premiums seemed not to occur to them.

The problem with a system grounded in private-sector insurance companies is that those companies have a fiduciary responsibility to shareholders to maximize profitability. Maximizing profitability in the insurance industry means maximizing premiums and minimizing claims. So the chief incentive of private insurance companies is to charge as much as possible and provide as little health care as possible. That's still the chief problem with Obamacare -- sicker people gravitate toward the program, healthier people gravitate away from it. With most Americans covered by employer programs and absent from the public exchanges, the premiums charged by private insurers on those public exchanges keep rising to reflect the sicker cohort enrolled.

As a result, many Democrats believe the logical conclusion is a single-payer system, Medicare for all, in which the entire country is in the same pool, and the administrator has no profit motive. This, of course, is anathema to Republicans, for whom "big government" is life's ultimate evil.

The Republicans' response was to lower insurance premiums by allowing private insurance companies to remove from their policies many of the things people need to be insured against. So, in an Alice-in-Wonderland kind of way, Republicans claimed people would be able to afford insurance policies that would turn out to be largely worthless if they ever got sick.

Large numbers of working-class Trump voters were horrified. Many Republican members of Congress were forced to run from their own constituents, as Colorado Rep. Mike Coffman famously did, exiting his own constituent meeting through a back door. In a poll taken last week, only 17 percent of Americans supported the Republican proposal that was pulled Friday.

We are better off without the GOP's health-care smoke and mirrors, but Republicans are right that the Obamacare exchanges are being rapidly abandoned by insurance companies because they offer unsatisfactory profit opportunities.

"We all learned a lot," Trump said. "We learned a lot about loyalty. We learned a lot about the vote-getting experience. We learned a lot about arcane rules, in both the Senate and the House."

As with health care itself, Trump is learning on the job how complicated governing is. The expert dealmaker was unable to close his first major deal as president. Maybe Obama playing more golf with Republicans wasn't the answer after all.

--Dave Krieger, for the editorial board. Email: kriegerd@dailycamera.com. Twitter: @DaveKrieger

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