Some days you read a presidential front-runner’s plan for our nation’s healthcare system that you plan to critique, and you remember that journalism can still be an important job. Other days that same candidate suggests on national television that his party’s last nominee would have blown him for an endorsement four years ago. But to have both those events occur on the same day puts the lie to Donald Trump’s campaign slogan, because America obviously is still great.
It feels almost superfluous to write about the healthcare reform plan that Trump released on Thursday. It’s not as if he remembers what he says about healthcare or any other issue from day to day anyway. One day he likes the individual mandate that is part of Obamacare. The next day he hates it and reassures everyone it has no place in his plans for his administration. It’s as if a walking goldfish with a head injury is leading the Republican race right now.
In fact, if you have read through Trump’s plan once, you have likely read it one more time than he has.
Still, it is important to take a look at this pile of regurgitated GOP talking points, because unlike what either Democrat will propose, this is a healthcare plan that could pass a Republican congress. Thus it is a good reminder of the stakes of this election.
Let’s look at the provisions listed in what Trump’s website laughingly refers to as a “policy paper.”
Completely repeal Obamacare. Considering how deeply embedded Obamacare is in our society, any repeal has to also have plans for the transition to a post-Obamacare world. Otherwise you’ll have millions of people getting tossed off their health plans, premiums going up, the return of unaffordable junk plans that only cover catastrophic care to the individual market…basically all the stuff that conservatives claimed was going to happen when Obamacare became law. Needless to say, the Trump plan makes no mention of how people would be covered by any kind of insurance during the time that Trumpcare would be getting up and running.
Modify existing law that inhibits the sale of health insurance across state lines. Ah, the famous “allow sales across state lines” that conservatives have been pushing for years. There are numerous reasons why this is a bad idea, which is why even some health insurance industry lobbyists are cool to it. Pro tip: If even insurance lobbyists don’t like a plan that would reduce regulations on their industry, it’s probably best to forget it.
Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. This is something of a giveaway to high-income families that itemize their deductions. Poorer tax filers rarely itemize, so a deduction has no benefit for them. Obamacare offers tax credits instead, because those are of equal value to any household that can claim them.
Allow individuals to use Health Savings Accounts (HSAs). Is anything stopping individuals from using HSAs now? Were they outlawed under Obamacare? You can encourage more use of them, but Mitt Romney tried that as part of his plan in 2012. Anyone remember who won that election?
Besides, if you’re so poor you have trouble saving money for anything, and you are relying on tax credits and subsidies to pay for your health insurance as it is, the chances you have a few dollars left over to drop into an HSA every month are pretty slim. Real champion of the everyday ordinary American, is Donald Trump.
Require price transparency from all healthcare providers… Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure. Another favorite of conservatives. “You should be able to shop around for lower prices, the same way you do when you want to buy a mattress or hire a contractor to put a new wing on your summer house!”
How this is supposed to work in rural areas where there might only be one hospital in a hundred-mile radius is beyond me. How it is supposed to help low-income folks who don’t have easy access to transportation that would allow them to travel to a hospital that will remove their appendix for a couple of thousand dollars less than the one close to their home is never going to even be considered. How this would help someone who needs emergency surgery and doesn’t have time for price-shopping is such an obvious but unaddressed question that you wonder if people who pitch this idea have ever had a medical emergency in their lives.
Block-grant Medicaid to the states. Another conservative shibboleth that would make the problem of the uninsured even worse. On the plus side, all those states that have refused the Medicaid expansion offered under Obamacare might change their minds. Of course whether Republican governors would actually use the money to care for their state’s poor or find a way to use it to fill in holes elsewhere in their budgets is an open question.
Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products… Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers. Oh look, we found one area where Donald Trump actually favors free trade! This is actually the one provision of the plan I doubt could pass even a GOP congress, because drug companies would lobby furiously against it and it’s easy to fear-monger on. The campaign ads practically write themselves: “Your grandma needed life-saving medication, but she tried to get around the price by sneaking across the border to Ottawa and buying a cheap substitute up there. Now your grandma is DEAD. Don’t let your grandma risk her life for cheap medicine. It just isn’t worth it.”
For someone who is supposedly stirring up populism, Trump has put out a healthcare plan that is decidedly un-populist. It would throw people off their insurance plans. It would basically be the system we had pre-Obamacare. In that sense, it is no different than the plans of any other Republicans running for president. Unfortunately for the nation’s poor, that is one of the reasons why he’s so popular.