According to the historian John Steele Gordon, “Trump May Herald a New Political Order,” there have been just four transformational presidencies so far in U.S. history:
- Andrew Jackson in 1828 moved the locus of political power sharply down the socioeconomic scale.
- Abraham Lincoln in 1860 preserved the Union, freed the slaves and turned the South into essentially a third world country for the next 100 years.
- William McKinley in 1896 ushered in an era of almost unbroken Republican dominance which lasted until the 1930s.
- Franklin Roosevelt in 1932 who overcame the Great Depression and greatly expanded the reach and power of the federal government.
Ronald Reagan in 1980, constrained by a solidly Democratic House, was less transformational than the four presidents above, even though he ushered in the era of Great Moderation which lasted until the Great Recession hit in 2007-2008.
Barack Obama in 2008 took office with strong Democratic majorities. However the last eight years have proved a disaster for the Democratic Party. They lost the House in 2010, the Senate in 2014, and Republicans now control most governorships and state legislatures as well.
Now consider Donald Trump’s strong political position as he takes office:
- The Republicans hold a big majority in the House and a small majority in the Senate. And ten Democratic Senators in states carried by Mr. Trump are up for re-election in 2018.
- He was elected to change the self-serving ways of Washington and owes little to the political establishment.
- His cabinet picks, many with excellent qualifications, signal profound changes in government policy, especially lower tax rates and a regulatory environment more friendly to business.
Conclusion. Mr. Trump has excellent prospects for achieving faster economic growth and therefore rising incomes for the blue-collar workers who provided his victory margin. If he can also improve life in the inner cities, as he has promised to do, he and the Republican Party will be unbeatable for many years to come.
It Does Not Add Up 
It is time to have an easily understood plan to achieve equitably available, ecologically accessible, just efficient and reliably effective healthcare for each citizen. Within in the first 5 years, not much in terms of cost or quality would occur. The next five years would see substantial improvement. The final arrangements to achieve a cost of healthcare at <12% of the GDP would likely by promoted by a higher level of economic growth. I also wonder if other issues might also be improved by the invigorated level of 'social capital' community by community, e.g., improved education from early childhood development intervention and a decrease in suicide and homicide.
To be more definite this progress, I have revised the NATIONAL HEALTH website HOME Page to succinctly describe a 15 year plan for healthcare reform. This healthcare reform would eliminate our nation's healthcare industry's contribution to the annual Federal deficit: 60% in 2015.
See: https://nationalhealthusa.net
The Republican Congress will clearly be proposing a replacement for ObamaCare in the very near future. What would you like to see in this new plan? What parts of ObamaCare would you keep and what parts would you replace with something different?
Here is a bias of mine. Where ever possible, we should avoid centralized governance, i.e., federalism. Each state or groups of States should have their own Exchange and the central exchange phased out. The penalty for no insurance does not apply unless this occurs repeatedly. An arrangement should be available for a temporary 3 month Emergency enrollment at any time. The cost to maintain the penalty is probably not worth the need for universal participation. Similarly, the unique status of Medicare Supplement Plans should be eliminated.
The Benefit structure for Primary Healthcare should be standardized for all plans; all insurance or other sources of economic support should verify a citizen’s Primary Physician: including Medicare, VA Benefits, Native American Health Service, the community health centers as well as the Plan maintained by Congress for itself.
Person’s who have had a portion or full calendar year of high costs, as in > $ 500,000, should qualify automatically for a Medicare Advantage Plan for 5 years. This qualification would start at the beginning of the high cost requirement for Healthcare and continue thereafter for a total of 3 years and then continue or not based on the usual qualifying criteria for Medicare.
The high deductible plans should only be sold to person’s with an income above a certain level, as a means to establish the presence of disposable income in the case of a healthcare requirement. Eventually, all the other plans should have as their core structure, a triad risk-sharing pool structure for Primary Healthcare, Specialty Healthcare and Hospital Healthcare. The pool structure would be stop-loss protected with various levels of risk-sharing based on physician group performance. Citizens with fully paid plans (Medicaid and Medicare) would require purchase order style referrals for a specialist, durable medical equipment and ancillary services. Remember, these types of plans stabilized the increase in the cost of our nation’s healthcare during the middle years from 1993-1998. The level of Federal Premium support would be based on income. Citizen fees would have a sensible cap.
The slowly introduced levels of physician group/hospital risk sharing is a must. It also must occur in conjunction with a Community HEALTH Forum related to @400,000 citizens. It is likely that certain adversities occur in many communities but by not all communities that significantly affect the HEALTH of their own community. The main issue for this process is to assure that Primary Healthcare is equitably available, ecologically accessible, justly efficient and reliably effective, community by community.
Within 15 years, I project that with universal health insurance, a Primary Healthcare Benefit structure that qualifies for augmented reimbursement via the three-pool risk sharing plans, and the augmentation of each community’s ‘social capital’ to augment their community’s ‘common good’ our nation’s healthcare should drop from >18% of the national economy to <12%. And, our nation's maternal mortality ratio should fall by 75% to rank among the 'best five' developed nations of the world instead of the current 'worst five' of the 46 developed nations of the world. A portion of the improvement would occur by the improved economic growth rate occurring after the healthcare industry no longer requires Federal deficit spending representing 60% of the annual Federal deficit.
This entire transition should be promoted and coordinated by a new, semi-autonomous institution that is Chartered by Congress. I like the name of 'NATIONAL HEALTH.' This institution would have no involvement in the direct distribution of economic support for healthcare. See my Blog site for details at
.
https://nationalhealthusa.net
I’m having difficulty placing your plan into the usual framework I use to compare different plans. Is it a “single payer” plan like many other countries have or does it have built in competition as a mechanism for keeping costs down? Or is it some kind of hybrid of these two basic models? There has to be some sort of mechanism to have such excellent potential of lowering costs as dramatically as you project!
It leaves the health insurance industry intact with an augmented ability to recognize the benefit for Primary Healthcare. I have today finished a revision of my Blog’s HOME page to describe its overall implementation plus a short segment for “Trumpcare.” Over-all, it makes timely sense to more formerly task the federal government as the payer for catastrophic re-insurance. The concept of distributed risk management applies, as discussed earlier.
see https://nationalhealthusa.net
Making the federal government the payer for universal catastrophic care is very comparable to providing a universal (refundable) tax credit to cover the cost of catastrophic care. So I think we’re on the same page.