On Thursday, President Trump is scheduled to give a speech on health care, quite obviously because he has realized what an enormous liability it is for him in the election:

President Trump is pushing advisers to deliver health-care “wins” in the final weeks of the campaign, leading to a frenzied rollout of proposals as polls show the president’s handling of the coronavirus pandemic and health-care policy are two of his biggest vulnerabilities in his reelection bid.
Trump is scheduled to deliver a speech Thursday in Charlotte, broadly outlining how he would approach health-care policy in a second term, though the speech is likely to be light on details. Instead, Trump will tout the administration’s efforts to lower drug prices, address surprise medical bills and improve health-care price transparency, according to two senior administration officials and an outside lobbyist familiar with the plans.
He is expected to mostly avoid speaking about repealing and replacing the Affordable Care Act, something he has long promised to do but a position that is ­unpopular with voters.

To be clear, “the administration’s efforts” in those areas generally amount to Trump signing an executive order instructing federal agencies to examine the issue in question. Actually addressing significant policy questions in health care would require legislation, something Republicans mostly stopped bothering with once they passed a tax cut.

So, in all likelihood, a second Trump term would likely feature what the first term has: regulatory and administrative efforts to undermine health security, with the president occasionally claiming that in two weeks he’ll release a fantastic health-care plan, which he never does.

Democrats, on the other hand, are eager to address the genuine problems in our health care system, such as the fact that in 2019, before the pandemic hit, nearly 30 million Americans were uninsured for at least part of the year. But there’s a danger ahead: that political success could make them pull back on what ought to be the next phase of their long battle to make our system something to be proud of, not the source of misery, exasperation and shame that it is now.

Consider this all-too-plausible scenario. In the next month or so, Republicans rush through Trump’s nominee to fill Ruth Bader Ginsburg’s seat on the Supreme Court. Disgust and condemnation is widespread enough — particularly the threat that the new 6-3 court majority will agree with a Republican lawsuit to nullify the entire Affordable Care Act — that it helps Joe Biden win the presidency and Democrats take the Senate.

But then it turns out that the court is not particularly eager to blow its legitimacy on what even many conservative legal experts consider an absolutely absurd suit. The court’s two savviest political operatives — John G. Roberts Jr. and Brett M. Kavanaugh — side with the liberals and reject the GOP’s assertion that the entire ACA must be struck down.

They have a much broader and deeper agenda in transforming the landscape of American law — undermining abortion rights, enhancing corporate power, destroying unions, limiting regulation of business and chipping away at voting rights. Making it clear so early in the new majority’s tenure that the court will just rubber-stamp whatever loony claim Republicans make is bad for the court’s image. So they take a pass.

Then Democrats celebrate: Twenty million people didn’t lose their health coverage! Protections for people with preexisting conditions survived! And then they feel like their major work on health care is done.

After all, there are things the Biden administration can do to through its regulatory powers to make health care more secure (starting with reversing the damage the Trump administration did). And besides, another legislative battle on the scale of what they went through to pass the ACA just looks so daunting.

The insurers and drug companies and hospitals and other well-resourced interests are just as opposed to Biden’s public-option plan as they are to Medicare-for-all, because any expansion of government-provided coverage threatens their profits. To even think about a sweeping piece of legislation of the kind Biden proposed, you’d have to get rid of the Senate filibuster anyway. Maybe Democrats put that off until after they’ve passed a big stimulus bill and controlled the pandemic.

This scenario is hardly far-fetched; for all the reasonable fear that the court will strike down the ACA, I suspect it’s just as likely that they don’t, and with everything else going on, there will be many Democrats who are not eager to have a knock-down, drag-out fight about health care.

But here’s the reality: They may only have two years, and if they give up the chance early in the Biden administration, they might not get it again for a long time.

The political future is hard to predict, but there’s a good chance that if Biden does win, an opposition backlash will give the party out of power a huge victory in the 2022 midterm elections, just as happened in 2018 and 2014 and 2010.

Which means that Democrats have a short window in which to accomplish all their legislative goals, including health care.

It won’t be easy, and it will require courage. The courage to say: We’re going to do this, because it’s what we promised and because it’s right. We’re going to address this problem — not just maintaining the victory we won a decade ago, but taking it where it should go now. We’re going to whatever is necessary procedurally, including eliminating the filibuster, to make it happen. And if there’s a political price to pay, we’ll pay it.

I’d like to say I’m confident Democrats will have that courage, but no one familiar with the party could be so naive. Right now, with no power in their hands, health care is merely an “issue” — a political factor that can be used to their advantage. Four months from now, more may be asked of them. We’ll see if they’re up to it.

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