Jack Bernard, a retired SVP with a large national healthcare firm, has worked extensively with hospitals across the nation regarding cost containment and insurance. He was also the first Director of Health Planning for the state of Georgia.

“Those who cannot remember the past are condemned to repeat it.”- George Santayana

Speaker Paul Ryan has seen the tsunami coming and jumped ship. Smart move, but the upcoming GOP disaster was totally avoidable.
The GOP apparently was surprised about the abject failure of their healthcare reform efforts. The failure to accomplish that or anything else of substance was a major factor in subsequently getting GOP moderates and conservatives on-board with the very unpopular Republican tax “reform” bill, a Christmas gift for corporations and the wealthy which will increase the ballooning deficit by $1 trillion or more per the CBO and others.
Even worse, the recent debacle with the GOP’s health reform proposals (Trumpcare, the AHCA) was entirely predictable. Time magazine’s 11-28-16 edition outlined several issues with the Trump campaign’s ideas, including:
the cutting of health insurance subsidies to middle class and working class taxpayers (leading to fewer covered), the difficulty of keeping the “good parts” (like prohibiting exclusions of pre-existing conditions) without a coverage mandate for everyone (including the young and healthy), leading to higher ACA premiums, throwing insurance markets into disarray by piecemeal changes which could end up having ill patients facing premiums “as high as $10,000 per month”, and insurers leaving the market due to these ill thought out changes.
As it turns out, these predictions were accurate due to Trump executive actions obviously intended to sabotage Obamacare (i.e. cutting advertising, the enrollment period, and so forth), the GOP tax bill eliminating the individual mandate which will result in 13 million losing insurance (3 million already have), and the inability of Congress to pass the Alexander-Murray bill which would shore up the ACA insurance market to prevent insurance companies from leaving.
Much of Trumpcare was developed as a result of radical ideas put forth by Speaker Ryan and then Sec. Price (DHHS). Their proposals were anything but mainstream and were totally unproven in the real world. The American public rejected them by a wide margin and more now want to keep Obamacare than do away with it (KFF, 3-23-18). From his public statements, Trump new appointee, Sec. Azar, supports these same failed policies.
Yes, President Trump, healthcare is complicated. Big surprise. Healthcare professionals like me understand this fact.
Why didn’t you have advisors who informed you? Why did you now appoint a drug company lobbyist as head of DHHS? Now, a future Congress and President will have to try to fix the mess you helped create.
Similarly, with the recent passage of the tax “reform’’ bill by the GOP (not one Democrat voted for it in either the House or the Senate), a disaster will be waiting for the next President and Congress. The best example would be to harken back to the supposedly conservative Reagan administration’s tax cut that created massive deficits.
We heard the same right-wing rhetoric then about the tax cut paying for itself, but that did not happen. Poor George Bush Senior tried to tell everyone at the time that it was “voodoo economics,” but no one in his party would listen.
During the Reagan administration, everyone enjoyed spending money that should have gone towards taxes paying for government services, and Reagan became popular, a conservative hero.
The tax cut did not pay for itself via increased economic growth, as Reagan said that it would. Therefore, “Congress undid a good chunk of the 1981 tax cut by raising taxes a lot in 1982, 1983, 1984 and 1987” (Brookings, 12-8-17).
In fact, when Bush was elected President, he was stuck with a ballooning deficit. A true conservative, Bush did the responsible thing and tried to balance the budget via reversing some of the cuts. For his efforts, he lost the Presidency.
Just maybe the American public learned from the failure of Reaganomics and supply side theory. Now, a majority are against the recent GOP tax cuts.
Per a Quinnipiac survey after its passage (11-15), “American voters disapprove 52 – 25 percent of the Republican tax plan. Republican voters approve 60 – 15 percent, with 26 percent undecided. All other party, gender, education, age, and racial groups disapprove.”
Subsequently, a GOP-led House and Senate approved another budget-busting appropriations bill, which was then signed by the President (a man who has bankrupted many firms during his career). Between this action and the tax cuts, deficits are on the way to reaching massive proportions.
The GOP leadership and the President better pray that Trump can reach beyond his base to sell the rubes on the fairy tale that the Democrats single-handedly created this fiscal morass. If our modern-day PT Barnum is unsuccessful, they all need to start looking for new jobs.