Healthcare Labyrinth blog logo

The GOP Primary: My Dilemma From A Healthcare Perspective And Other Policy Issues

Update: Posted early on January 1/15/2024 — Martin Luther King Day. The Iowa Republican Caucuses were on 1/15. After the Iowa Caucus results, Vivek Ramaswamy dropped out of the presidential race and endorsed Donald Trump. In Iowa, Trump won at least 20 delegates, at least DeSantis 8, Haley at least 7, and Ramaswamy at least 3.

While you have learned I definitely have opinions, I try to keep politics per se out of my blogs. You do know, though, I am a Republican. As we approach the primary season, I have to try to pick a candidate. My decision will be a mix of healthcare and non-healthcare issues. So here is how I view it. As a Florida resident, I have until March 19 to make my decision on whom I want to win the GOP nomination. Forgive my delving into non-healthcare issues, but I believe the nation is on the precipice.

The GOP Candidates

At this writing, the leading candidates for the Republican nomination are former President Donald Trump, Florida Governor Ron DeSantis, former South Carolina Governor Nikki Haley, and businessman Vivek Ramaswamy. For the latest polls, I usually go to Real Clear Politics, which actually is co-publisher of my book, The Healthcare Labyrinth (available at this site). As we know, Trump is way ahead with a 50 percentage point lead, with Haley and DeSantis fighting for second place at about 11 percent. Many are focusing on Haley and DeSantis in case something happens in the numerous legal cases against Trump.

The Non-Healthcare Issues: January 6 and Foreign Policy (More Specifically On Ukraine)

I have removed Trump and Ramaswamy from my list for a few reasons.

In the case of Trump, whatever you believe happened on January 6, 2021, it is hard for me to countenance his behavior that day and leading up to the events. It does not matter if it was insurrection or not. He lost numerous court battles challenging vote counts and outcomes in states. Still, in a speech on the day of the certification of the election by Congress, he continued to question the election results and argued Vice President Mike Pence should somehow reject the certified results. There was no reasonable legal basis for this. It was an attack on democracy.

In the case of Trump and Ramaswamy, I removed them also due to their foreign policy views. Ramaswamy is dangerous. He is inexperienced in foreign policy and has an extreme geo-political view of things. None of his views appear to be rooted in freedom and democracy. He would carve up the world without regard to right and wrong, good or evil. He wants to cut off aid to Ukraine and in essence allow Russia to take over. He seems just fine with Communist China’s absorption of a free and democratic Taiwan as long as we have time to build semi-conductor capacity before the island’s invasion.

In his years as President, Trump’s personal approach to foreign policy destabilized America’s position in the world. He attacked NATO and befriended dictators like Kim Jong Un of North Korea and Vladimir Putin of Russia. He says he can settle the war in Ukraine in twenty-four hours, which inevitably favors Russia and his friend Putin.

That leaves Haley and DeSantis.

DeSantis has no experience in foreign policy. Haley does. While DeSantis has been more equivocal on Ukraine than Trump or Ramaswamy, DeSantis seemingly bows to populist isolationism and refuses to commit to Ukraine aid and funding. Together, Trump, Ramaswamy, and DeSantis seem to be fine with the terrible war crimes and aggression of Russia in Ukraine – at least they don’t talk of them. Haley believes as I do that aid is important for the freedom of Ukraine, the stability of Europe, and for democracy and free markets more broadly. She also thinks Putin should be held accountable for his war crimes and aggression.

Governance and Pragmatism

It is important that our next President be proven in governing. While many argue that change is needed in Washington and the swamp drained, I also think a knowledge of government and a track record of governance is key. I would say that both DeSantis and Haley have this. DeSantis was in Congress and understands Washington. He is in his second-term as Governor of Florida and has run the state well. 

Haley has a similar record.  She was in her second term as South Carolina governor when she left to become U.N. Ambassador under Trump. As well, while she has staked out positions on the various issues of the day, Haley seems to have more nuanced views and pragmatism on various issues of the day – something that cannot be said of DeSantis. This gives me hope that she would govern with relative moderation as president, including on the issue of the Affordable Care Act (ACA) noted below.

The Healthcare Issues

DeSantis and Haley look more alike on healthcare issues and do not seemingly align with my views on coverage expansion.

On drug prices, DeSantis fought for drug importation waivers for Florida, while Haley speaks of the need for transparency in healthcare. But neither can be counted on as a supporter of more sweeping drug price reform or major healthcare reform in general.

As Governors, they refused (or still refuse in DeSantis’s case) to expand Medicaid as part of the ACA. As you know, I believe the ACA makes sense as Medicaid is a cost-effective way to bring coverage to the uninsured.

Most troubling, both have gone on record saying they would like to convert the ACA into a state block grant – an old and tired idea that couldn’t pass Congress before and would increase the uninsured rate (not lower it). That raises the question: is this just election year rhetoric to ingratiate themselves to right-leaning primary voters or would they truly go after the ACA? We know Trump would if he had a Republican Congress. He already has. My instincts suggest DeSantis would as well. I question whether Haley would for a few reasons:

  • She quietly expanded some Medicaid in her state for certain populations.
  • She tried to tackle some healthcare outcome issues as Governor.
  • She seems someone who does not want to upset the status quo unless it is entirely broken or headed that way.
  • While both are Governors and chief executives of state, she seems more sensitive to the upheaval that ripping apart the ACA would have on tens of millions of Americans.

The Necessity of Entitlement Reform

While I am still undecided due to her views on the ACA, Haley deserves credit for her position on entitlement reform, which is fraught with political peril. Polls do seem to indicate that Americans understand the need for reform of our entitlements generally. But at election time, a majority of voters seem to tell pollsters that candidates should leave their hands off of Medicare and Social Security.

Nonetheless, Haley has raised the issue of entitlement reform and says she wants to tackle the issue. She said in September: “I recognize that Social Security and Medicare are the last thing the political class wants to talk about. … (But) any candidate who refuses to address them should be disqualified. They’ll take your vote and leave you broke.”

 While she hasn’t said she would go after those already collecting benefits, her opponents mislead voters and attack her on this. Haley has said she would increase the age at which younger workers would become eligible for Social Security benefits and limit the benefits the wealthy receive. At the recent debate, she reiterated her stand by saying that the retirement age for both Medicare and Social Security should be raised for younger Americans.

Democrats seem fixated simply on raising taxes to fix these and other problems. Ever populist and opportunist Trump refuses to discuss any changes. DeSantis is not altogether against reform, but he has distanced himself from congressional votes on entitlement reform and talks in much greater generalities (arguing for bipartisan reforms). In the recent debate, he trumpeted Trump and said he would not raise Social Security’s retirement age.

So as others bury their heads in the sand on the cost of entitlements, Haley shows greater maturity as a leader. While I am still thinking about who gets my vote in the GOP primary, I am impressed by her overall. She is more experienced, holds more nuanced views, and appears more pragmatic. I dislike Haley’s position on the ACA, although I hope it is just election-year posturing to the Republican base. She seems capable of setting politics aside on important issues (healthcare and non-healthcare) and attacking problems.

Given the current GOP primary polls and what appears to be the inevitability of Trump capturing the nomination, I also continue to track the potential for a No Labels ticket. It may be important to the future of our nation. Perhaps more on this in the future.

Interesting reading:

https://kffhealthnews.org/news/article/gop-presidential-debate-haley-desantis-health-care-issues-trump-town-hall/

https://www.cnn.com/2023/12/05/politics/nikki-haley-social-security-medicare-reform/index.html

https://kffhealthnews.org/news/article/nikki-haley-health-policy-governor-president-agenda/

#2024presidentialrace #gopprimary #trump #desantis #ramaswamy #haley #healthcare #healthcarereform #coverage #aca #medicaid #exchanges #obamacare #socialsecurity #entitlementreform

— Marc S. Ryan

Available Now

$30.00