Trump on health care

I cannot believe we actually have to discuss presumptive GOP Presidential nominee Donald Trump’s health care plan.

Trump’s website calls for few specifics; most are recycled from other GOP positions while some directly contradict his past statements about healthcare or standard GOP health reform views. Moreover, he has been wildly inconsistent and often downright contradictory, often promoting then disavowing specific policy ideas in the same speech.

Notably, a couple positions contradict basic conservative ideology as well.

In fairness, buried in the dog’s breakfast that is Trump’s healthcare plan there are a couple good ideas.

With those rather major caveats, here’s what Trump says – as of this moment – about his plans for healthcare reform.

1. Repeal Obamacare – but keep the mandate banning insurers from considering pre-existing conditions.
2. Allow the sale of health insurance across state lines
3. Full deductibility of individual health insurance premiums
4. Allow individuals to use Health Savings Accounts
5. Full pricing transparency for all health care providers
6. Change Medicaid to block grants
7. Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products.

Rather than getting into an analysis of each of these “ideas”, let’s look at the overall impact.

First, the number of Americans without health insurance would immediately explode. About 21 million people have gained coverage under ACA; they would likely lose that coverage. Unless insurers can figure out how to comply with Trump’s requirement that insurers have to cover anyone regardless of pre-existing medical condition without going bankrupt.

If not, only healthy people would be able to get health insurance.  Health insurers would immediately begin canceling and/or non-renewing and/or not offering policies for individuals, families, and employers with many health conditions/diagnoses.  This is a matter of survival, as any healthplan forced to cover sick people would quickly find its costs exploding while healthy members fled to lower-cost healthplans.

This is fundamentally unworkable; you can’t require health insurers to cover people who aren’t forced to buy insurance, as only sick people will buy insurance. 

Notably, there’s no mention of what Trump would do to address this.

Third, full tax deductibility of premiums makes consumers less sensitive to the cost of health insurance and healthcare, a violation of conservative free market ideology.

Fourth, health care providers would have to comply with an as-yet undefined governmental bureaucracy regulating “transparency”, with requirements around posting prices, updating same, making this information available to consumers, and enforcing these regulations. If anyone thinks healthcare providers would not instantly figure out how to game this, they’re hopelessly naive.

Finally, the American health care industry is in the midst of adapting to PPACA, a process that is well underway. The changes are monumental for every stakeholder.

Any individual with an IQ above that of your average tomato plant would understand that throwing the brake switch to stop a runaway train will kill most of the passengers.

The net – Trump’s ideas are either totally unworkable and/or widely discredited. He does not have an ideologically consistent, coherent or even remotely intelligible health care plan.