Today, Donald Trump released a Healthcare Reform plan on his website. To be completely fair, it isn’t complete garbage, but it is heavily-perfumed garbage. The TL;DR version: Obama is the Worst. President. Ever. and we need to undo what he did.
The opening paragraph is purely pandering vitriol. Trump refers to Obama as “the most divisive and partisan President in American history.” I’m pretty sure, by definition, Abraham Lincoln was the most divisive President in American history, and Obama didn’t have his minions break into RNC Headquarters like Nixon did. Mostly, the paragraph describes either things that happened when Obamacare first came into effect, like website issues, or things that Republicans wish happened but didn’t, like rationing–which was happening long before the Affordable Care Act.
Trump’s plan has seven points:
- Completely repeal Obamacare. Stupid pandering. The ACA did many necessary things besides require everyone to have health insurance, such as prohibit insurers from denying coverage based on existing conditions. (I refuse to use the word “pre-existing.” How can something exist before it exists?)
- Modify existing law that inhibits the sale of health insurance across state lines. This one could be very good or very bad. If there are safeguards put into place to prevent excessive consolidation, greater competition should help control price increases. I don’t see Trump being too concerned about preventing consolidation, given his pro-business background, so this could backfire–badly.
- Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Yeah, this makes sense.
- Allow individuals to use Health Savings Accounts (HSAs). Again, this makes sense, but there’s the one line that bothers me: “These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty.” This looks like it could become a tax dodge for the wealthy: It needs limits.
- Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Agreed. People can’t comparison shop if they can’t easily access price data.
- Block-grant Medicaid to the states. I don’t necessarily have a problem with this either, provided that there is sufficient oversight to prevent gross abuses.
- Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. U.S. consumers pay more for prescription drugs than anyone. Allowing competition from foreign sources could help drive down costs.
Here’s the interesting thing about all of these: None of the last six require the repeal of Obamacare to work. Congress could likely have passed bills on any of them at any time, and President Obama likely would have signed them into law.
The rest of the statement is less about healthcare and more about Trump’s general positions: Anti-immigration, pro-business, Make America Great Again. I will give him some credit for knowing that the issues are all connected, but he really misses the boat on a big one…
America Needs Single-Payer Healthcare To Compete Internationally In Manufacturing
Almost all of the developed world has single-payer healthcare, and international trade laws reflect this. One of the largest expenses for American automakers is employee healthcare. German, Japanese, and Korean automakers don’t have this expense, making their employee healthcare a legal trade subsidy. If the government were to subsidize this expense, it would be a violation of trade law, resulting in punitive tariffs. So, what we have is an unfair playing field, and it’s only due to extremely efficient manufacturing that U.S. automakers are able to export at all.
If we implemented a single-payer healthcare system, manufacturing jobs would immediately start to return to the U.S. What I would like to see is the replacement of Obamacare with a single-payer system that covers the basics: Preventative and wellness care, like annual check-ups and vaccines, along with basic healthcare that is equivalent to a bare bones HMO. No doctor or facility choice, no bells and whistles. From there, we create a hyper-competitive market to sell supplemental insurance, like the plans currently available for Medicare recipients. This is where Trump’s suggestion to remove the state line sales restrictions could really help keep costs down, where HSAs could be a good alternative to supplemental insurance, and where being open about pricing could help consumers shop around.
Trump’s #2 through #7 aren’t bad, but there’s nothing stopping them from being implemented now–besides a Republican Congress too pig-headed to give up on the idea of repealing Obamacare while Obama is still in office. Unfortunately, if Trump gets elected he won’t be able to get a bipartisan coalition needed to both repeal Obamacare and pass the rest of the plan, and he’s (probably) too stubborn to split it into its component parts, because what he needs to do to be able to point to a success is to repeal Obamacare. That’s the core of his plan, and it stinks.
Thanks for reading.