Unanticipated, the ruling by a federal judge that the American Health Care Act (AHCA) is unconstitutional may have provided a timely holiday present and a needed opportunity to heal. Previously I described our conflict over health care as a war. The struggle can be seen as ongoing and relentless, but not surprising since Democrats and Republicans speak a different language and measure success in metrics far apart from each other; without a truce the war would likely continue unabated. The recent ruling over a lawsuit brought by a group of Republican governors and attorneys general is simply the latest foray.
The partisan conflict is unfortunately not limited to health care, and it is not just health care that is now subject to judicial scrutiny. In fact, a recent ruling by a Federal judge to fully restore Deferred Action for Childhood Arrivals (DACA) temporarily stops a proposal to end that program. Whereas one ruling may have been applauded by Republicans and the other by Democrats, both are likely to be appealed, divisive, and disruptive, causing substantial uncertainty.
Since the underlying ideological dogma is equally distant and not reconcilable, the possibility of a negotiated policy compromise appears to be remote. So, perhaps it is now time to end the war, send the troops home and negotiate a peace treaty. These two judicial rulings may have provided the roadmap to do so.
Previously I described a health-care compromise envisioned as a plan that could satisfy the ideological necessity for both Democrats and Republicans alike. This plan called for isolating and reassembling EHB component services into a lineup of plans optimally designed to be flexible and responsive to patient choice. It also called for a provision that would allow any person with a pre-existing condition to enroll in Medicaid for a premium based on an income-determined sliding scale and would allow persons 55 and older to buy into Medicare with the payment of an unsubsidized market-based premium.
President TrumpDonald John TrumpPresident Trump, first lady attend Christmas service at National Cathedral Trump open to visiting Turkey in 2019 but no ‘definite’ plans, White House says Trump has weighed dismissing Mnuchin: Bloomberg MORE proposed a plan to provide resolution and certainty to DACA eligible children (dreamers). In his plan, he called for a path to citizenship for dreamers, the building of a wall along the southern border, an end to chain migration, and an end to the immigration lottery.
Republicans could offer what would be seen as a significant concession to Democrats by allowing a path to citizenship for dreamers, allowing persons with a pre-existing condition to enroll in Medicaid and those 55 and up to buy into Medicare.
Democrats could make a significant concession to Republicans by allowing flexibility in EHB component service design that is responsive to patient choice, the building of a wall, an end to chain migration, and an end to the immigration lottery. Together, these concessions would transcend the politics of the day and would likely achieve strong public support.
Public support would likely be long term, broad based, and sustainable finally putting an end to these policy wars, perhaps make unnecessary any further judicial review, and providing the basis and time for our nation to heal.
Richard Manski is professor and chair of the department of dental public health at University of Maryland School of Dentistry.