Tag Archives: Donald Trump

What’s wrong with Trumpcare (so far)

 

false-98375_640

As a college student many years ago I had a summer internship at a top consulting firm, where I learned an important lesson from my boss: “Don’t come tell me about a problem without proposing a solution.” It went without saying that before speaking up I was expected to focus only on real problems, analyze the situation, and propose realistic, logically consistent solutions.

I’m reminded of this lesson pretty much whenever I hear Donald Trump say something, on subjects ranging from immigration to the environment to foreign policy. If he were a summer intern he would have been fired, and We the People should have known better than to hire him for his current gig.

Trump has no problem calling the Affordable Care Act (ACA) a “complete and total disaster” and saying everything should be thrown out the window and replaced with “something terrific.” But if you listen in recent days it’s become clear to me that Trump doesn’t even know what the Affordable Care Act includes. I’m sure if a reporter asked him to name five key elements of Obamacare he couldn’t do it, not that he could be bothered to try.

The things Trump says he wants to achieve are mainly in line with the objectives of the ACA itself. Furthermore, the ACA has achieved some or a lot of success in many of these areas. To the extent Trump has backed different approaches, they are either irrelevant, ineffectual, contradictory, or fiscally unsound.

Trump said in his speech to Congress that he wants to replace the ACA “with reforms that expand choice, increase access, lower costs, and at the same time, provide better healthcare.” He continued with talking points that he and Congressional Republicans have used in the past:

  • Allowing the sale of insurance across state lines –which unlike what Trump said, will not lead to a national market nor achieve the other goals. In any case, selling across state lines isn’t forbidden today but there’s little interest in it from health plans themselves because they would have to set up local networks and wouldn’t have leverage to negotiate with local providers. It’s just policy ideologues and ignoramuses who think this will work. (It also requires contradicting typical Republican views about states rights.)
  • Ensuring that people with pre-existing conditions have access to coverage is a cornerstone of Obamacare, and a successful one at that. So it isn’t something Trump or Republicans can take credit for and was never a GOP goal before the ACA. If we’re going to be pure about a full repeal of Obamacare, why leave this –and other popular provisions—in place?
  • “Giving our state governors the resources and flexibility they need with Medicaid to make sure no one is left out.” –Well if making sure no one is left out is the goal then the states should accept the Medicaid expansion. Shifting to block grants may provide flexibility but won’t add resources
  • The use of tax credits and Health Savings Accounts to allow individuals to buy plans of their choice (not ones “forced by the government”) is just fancy words. Tax credits would have the same objectives as the current subsidies for premiums and out-of-pocket costs but they would probably be less efficient. If the credits aren’t refundable and/or they are based on age but not income, it won’t help poor people buy insurance. And if people can buy whatever plan they want it will help young, healthy people who want bare bones coverage but will make insurance more expensive for everyone else. Already, Trump’s instructions to the IRS not to penalize people who don’t buy insurance is undermining the Obamacare exchanges rather than helping them
  • Malpractice reform. Sorry, that will have no meaningful impact
  • “Bring down the artificially high price of drugs and bring them down immediately” –No word on how that would be done, certainly not immediately.

It’s notable that none of these so-called principles actually deals with improving the delivery of healthcare. They’re all about insurance and financing.

He concluded “On this and so many other things, Democrats and Republicans should get together and unite for the good of our country and for the good of the American people.”

Amen to that. A good way to start would be for Trump and the rest of the GOP to apologize for demonizing and undermining the implementation of Obamacare and then work on improving it. With hardliners from the ironically named Freedom Caucus likely to oppose pragmatic policies, it’s up to the GOP to persuade Democrats why they should go along.

By healthcare business consultant David E. Williams, president of Health Business Group.

Goodbye Obamacare? More like hello single payer!

id-100394369

Once Donald Trump enters office, Republicans will be in a good position to repeal Obamacare, something they have been foaming at the mouth to do for quite some time. Democrats might be able to filibuster to prevent an outright appeal, although the majority has other ways to gut the law, such as the reconciliation process.

I say let them go ahead and repeal Obamacare without putting up a big fight. As Trump told 60 Minutes, “I am going to take care of everybody. Everybody’s going to be taken care of much better than they’re taken care of now.” He also promised to provide “quality, reliable, affordable health care.”

I look forward to hearing the great ideas revealed by Trump and the Republicans in Congress. If they can do what they say then I’m entirely in favor of it and will give them the credit that’s due.

Meanwhile, I’m going to feel free to criticize the stock initiatives of the Republican party, which were largely mirrored in Trump’s campaign statements:

  • Repeal Obamacare, by which they really mean keeping the popular pieces like making health plans accept members with pre-existing conditions without charging higher premiums, but at the same time jettisoning the unpleasant aspects such as the individual mandate and taxes that help subsidize coverage. Sounds nice, but without a mandate, plans will suffer from adverse selection, premiums will skyrocket, and people will be left uninsured
  • Let health plans sell insurance across state lines. This one is highly touted but in reality it’s a big yawn. The plans themselves have little appetite for moving across borders and even if they did, most new entrants won’t be able to establish strong enough negotiating positions in the markets to bring down premiums
  • Change Medicaid to block grants so states can do what they want with the money. This isn’t a terrible idea because it could allow states to more freely innovate and tailor Medicaid to meet local needs. In practice it’s likely to be used just as a way to screw the poor
  • Promote drug re-importation. Remember the senior citizen buses to Canada in the 1990s before Medicare Part D and the mail order pharmacies with drugs supposedly from Canada, that disappeared once Obamacare required drug coverage? Well, the GOP might bring these back. But the drug market has changed and the most pricey new meds won’t necessarily be attainable from abroad anyway
  • Let individuals who buy their own health insurance take a tax deduction the way businesses already do. Again, sounds great in theory but it’s a regressive approach that rewards higher income people who are in the top tax brackets. It also encourages premiums to rise and widens the budget deficit. The Cadillac tax or some variant that limits deductibility by businesses is more fiscally responsible
  • Expand Health Savings Accounts (HSAs), allow them to be shared among family members and passed on as part of one’s estate. Not a bad idea but hardly a game changer in its own right

Remember, thought, that the Republican ideas above were presented by conservatives, while Trump himself has been at least a liberal and frankly more of a socialist when it comes to health care policy, at least based on his earlier writings. Once he learns that the ideas of the conservatives in Congress won’t produce universal coverage, he may well go back to improving –instead of replacing– Obamacare, moving to a Canadian style single payer system, or opening up Medicare for all, just like Bernie and much more radical than Hillary.

I can’t wait to see how it all plays out.

Image courtesy of Thanamat at FreeDigitalPhotos.net


By healthcare business consultant David E. Williams, president of Health Business Group.

 

Donald Trump or Dwayne Camacho for president?

Donald Trump is a clown, and his popularity among voters reflects poorly on the electorate and bodes ill for our society. The 2006 movie Idiocracy provides an entertaining view of where the dumbing down of society and politics is leading us. You should watch the whole thing. Meanwhile, here’s one of my favorite scenes: President Dwayne Elizondo Mountain Dew Herbert Camacho’s address to Congress. The Donald’s got nothing on him!

Idiocracy – President Camacho Speech from ChEeZe BaLL on Vimeo.