Obamacare, Brexit and the complexity problem Premium

Obamacare, Brexit and the complexity problem Premium

Legislation is much harder to unpick than governments think, writes Gideon Rachman Instant Insight

The troubles of Donald Trump’s healthcare reforms and Britain’s Brexit negotiations have something in common. In both cases, they reveal the difficulties of translating populist politics into practical policy.

During the US presidential election, Mr Trump energised conservative voters with his promise to scrap “Obamacare” — which he denounced as a total disaster. The Republican candidate was vague about what exactly would replace the Affordable Care Act, passed during the Obama administration. But he was quite certain that it would be “great”. For Trump enthusiasts this was enough. Obamacare had become a symbol of an over-mighty and inefficient government. And Mr Trump, a successful businessman, had assured them that replacing it with something better is “going to be so easy”.

The sad fact is that Brexit makes repealing Obamacare look simple

Within a month of being sworn into office, however, Mr Trump was complaining that “nobody knew that healthcare could be so complicated”. This, of course, is blatantly untrue. Providing affordable, comprehensive healthcare is a central problem of public policy across the developed world. It defeated the Clinton administration. And even defenders of Obamacare admit that the scheme has flaws and anomalies.

But Mr Trump has never shown any particular interest in engaging with the complexities of healthcare reform. As a candidate, he was interested in using the issue to rally his supporters. And, as president, he has been chiefly interested in notching up a legislative “win” without worrying too much about the precise contents.

However, the effort to repeal Obamacare has revealed deep divisions within the Republican Party in Congress — which has to deliver a bill for the White House to sign. Some arch-conservatives are intent on reducing the power of the state and slashing public spending, come what may. Other more moderate figures worry about stripping health coverage from their constituents. As a result, the Republican effort to repeal Obamacare has fallen apart.

The Brexit story is strikingly similar. Leaving the EU was the totemic demand of the populist right in Britain — with “Brussels” serving the same purpose as “Obamacare” in America, as a symbol of waste and of government that was simultaneously remote and intrusive. During last year’s referendum campaign, the Brexiters gave the impression that leaving the EU would be a straightforward matter. The UK would announce its withdrawal, stop payments to the EU, regain full control over immigration, restore parliamentary sovereignty, negotiate free trade with the EU — and launch into a prosperous new future as “Global Britain”. Anybody who suggested that things could go badly wrong was dismissed as part of “Project Fear”.

In reality, Brexit has proved to be fearsomely complicated, touching almost every area of public policy, from the nuclear industry to farming and aviation. Despite setting up an entire new government ministry to handle Brexit, the UK government gives every sign of being unable to cope with the administrative and diplomatic complexity. It seems increasingly likely that the UK government may simply prove incapable of delivering an orderly Brexit — just as the Trump administration has so far proved incapable of repealing and replacing Obamacare.

But the sad fact is that Brexit makes repealing Obamacare look simple. The Trump administration is trying to unpick a piece of legislation that has been in place for just seven years — and that involves just one area of public policy. By contrast, the UK has been a member of the EU for almost half a century (since 1973), which means that European law is now enmeshed in every area of public life.

The biggest difference is also the most dangerous for Britain. If healthcare reform fails in America, Obamacare simply remains in place. But if the British government cannot master the complexity of the Brexit negotiations, Britain will, on its current course, simply crash chaotically out of the EU in March 2019. Who knew it could be so complicated?

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