Donald Trump’s Healthcare Plan is as Incoherent as You Might Imagine

Update: Sarah Kliff at Vox points out that Trump’s plan does not include a ban on not covering pre-exisitng conditions, a very important tenant of reform. Read her take as well.
Donald Trump has released a seven-point healthcare plan that relies on contradictory assumptions and misrepresentations of the current state of the healthcare system in this country. After reading it, I feel compelled to respond to each point one-by-one. First off:

1. Completely repeal Obamacare. . . . eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.

Setting aside the grammatical problem with stating that a person shouldn’t be required to do something unless they want to, the ACA does not actually require anyone to buy insurance. It uses a tax incentive to strongly encourage people to buy insurance while providing them with viable options to do so, something Trump’s plan would also attempt to make use of. (See point 3 below.)

2. Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.

For better or worse, the prohibition of selling insurance over state lines is about all there is that prevents consolidation of the industry which would severely reduce competition. There may be better ways to prevent a slouch toward monopoly than the current law, but eliminating it alone will make things worse.

3. Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.

The first part of this seems to be implying that we should create a backdoor system through the tax code for the government to indirectly pay for all medical expenses, a kind of Rube Goldberg single-payer system. The latter part and its reference to “basic options for Medicaid” doesn’t seem to mean much, just typically empty efficiency promises. The middle sentence about the “free market” makes no sense at all. Who exactly is Trump proposing pay for healthcare? It’s impossible to tell from this mess of words.

4. Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. . . . These funds can be used by any member of a family without penalty. . . .

First let’s get a good laugh about his novel use of the phrase “death penalty”. Then I’ll point out that few people have the money to deposit in HSAs. This part might be a boon to the upper middle class but few other people.

5. Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.

This is a common fallacy in analyses of the healthcare system, that health services are just like any other consumer good. I’ll leave it to better people to explain why but the most important reason is that modern medicine requires the kind of expertise that is hard to come by. And I should also point out that this only matters if you are paying for services directly. If your insurer is paying for all or part of them, this entire point is irrelevant.

6. Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. . . .

“Block-grant” is idealogical code for “money without restrictions” attached to it. Does anyone do anything more efficiently if given money without being required to achieve a particular goal with it? Some states (depending on the make up of their government) may use it well, some may not. The fact that they “can” does not guarantee that they will. This is not a magic bullet idea as it is always sold to be.

7. Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.

Bwahahahahahahahahaha. Sorry. Couldn’t help myself. This is not going to happen. Lobbyists will shred any bill containing this kind of language. But let me also point out that the pharmaceutical industry does not provide a “public service”, the government does. You want to reduce drug costs, the government will have to get more involved not less. This is “public service” by definition.

Look, I know a lot of people hate government and/or don’t trust it to tie its own shoes(?) However, plans like Trump’s are the equivalent of rearranging deckchairs on the Titanic. Real, substantial change requires us to reform everything from how medical research is paid for to how we pay for individual procedures to how we get people to make healthier choices in their own lives. The ACA may be inadequate but it attempts to push reform in the right direction and establish momentum toward a particular end goal, some type of comprehensive government-run system. Replacing it with a diffuse set of policies that don’t cohere at all is a ludicrous notion, but given Trump’s lead in the polls, an all too real possibility.


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