In the vice-presidential debate, U.S. Sen. JD Vance (R-OH) signaled a major change in Republican health care policy; but if you weren’t looking for it, you might have missed it.
After years of Republicans promoting a centralized system that pays for prescription drugs and services through Politburo-approved benefit sets, the Republican vice-presidential nominee signaled a surprising shift towards federalism when he proposed that states ought to become the laboratories of health care policy.
States’ rights are generally promoted by Republicans, but the words behind Vance’s deference to the states sounds a lot like Robert Fitzgerald Kennedy Jr’s stump speeches promising to “make America healthy again.” RFK Jr’s overlap with conservative America’s views on the Food and Drug Administration (FDA) as well as the federal response to the COVID-19 pandemic created the heretofore unimaginable alliance of MAGA and RFK.
Thought leaders like Tucker Carlson were drawn to Kennedy during the pandemic when he was being attacked for defending the same positions that Carlson and other conservatives had adopted. In 2021, Kennedy wrote The Real Anthony Fauci, which accuses Fauci of controlling funding streams to create a decades-old corrupt medical swamp in Washington, DC.
Kennedy’s fight against that corruption led him to seek the Democrat nomination for president against a weakened sitting president of the same party, just as his father had done in 1968 and his uncle Ted also did in 1980. Forced out of the nomination fight by his own party, RFK successfully fought to get his name on the ballot as an independent before ultimately endorsing Trump.
Although no specific roles were discussed on a leaked telephone call between Trump and Kennedy, Trump’s former director of the Centers for Disease Control and Prevention (CDC), Robert Redfield, pitched Kennedy for a post leading childhood health care reform. If Kennedy did ask to be on the team, perhaps he borrowed a question Trump put to the residents of New York City’s toughest borough, when he asked, “What the hell do you have to lose?” If Trump was honest, the answer would be “not much.”
In his Sept. 10 debate with Kamala Harris, Trump was criticized for claiming to have only “a concept of a plan” to replace Obamacare. That same week, Kennedy wrote, ”Mr. Trump has told me he wants to make ending this chronic-disease calamity a key part of his legacy, while Kamala Harris has expressed no interest in this issue. His political courage and moral clarity about the danger of our compromised institutions give us the best opportunity in our lifetimes to revive America’s health.” That sounds like a pretty conservative plan to reform the FDA, CDC, and pull money out of the system by getting a handle on the exploding cost of chronic disease, which is well north of $4 trillion per year.
Republicans controlled Congress from 2017 to 2019. Their failure to follow through on their oft-repeated promise to repeal and replace Obamacare overshadowed Trump’s openness to state reform. Trump, a practical businessman and political neophyte, was frustrated with the health care battle lines between Republicans and Democrats in Washington. He owed little to Big pharma, the insurance industry, or the Chamber of Commerce, who reenacted battles from their familiar entrenched positions. Trump sought out and approved waivers to allow states to care for people in pioneering ways with federal dollars. Much of the focus reflected fraud prevention and work requirements, but Vance hinted at a possible shift towards reform on the delivery side (traditionally Democrat turf).
Trump wants to “allow states to experiment a little bit on how to cover both the chronically ill, but the non-chronically ill,” Vance said in the debate. “It’s not just a plan. He actually implemented some of these regulations when he was President of the United States,” Vance continued. While the plan is not totally fleshed out, these “experiments” could allow caregivers to treat patients to manage health rather than simply rationing care and time to serve corporate interests.
The failure of Democrats to make good on the promises of Obamacare, and Republicans’ failure to dismantle it, creates an opportunity to do something substantial if Trump gets another term. RFK does not have the trust of congressional Republicans, but Vance does. Together, they could present a potent force in the narrow but crucial area of health care reform.
After the assassination of his brother, Robert Kennedy Sr pursued the War on Poverty. That led him in 1968 to eastern Kentucky, where RFK highlighted the devastating effects of poverty. A half century later, JD Vance wrote Hillbilly Elegy, a first-hand account about the same poverty from the same streets and front porches. RFK’s words from a speech in 1968 would be eaten up at any Trump rally in 2024. “This is the violence of institutions–indifference, inaction, and decay. This violence that afflicts the poor is the breaking of a man’s spirit by denying him the chance to stand as a father and as a man amongst other men.”
Under a second Trump term, RFK Jr and Vance could very well be the right team to drive meaningful health care reform.
