Trump: Everybody Gets a Pony! But Maybe Not Health Insurance

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Bad Hair, Health Care, Medicare, Republican Party

By now you’ve probably heard that Trump is putting the finishing touches on a health care plan that will provide health insurance for everybody.

President-elect Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Obama’s signature health-care law with the goal of “insurance for everybody,” while also vowing to force drug companies to negotiate directly with the government on prices in Medicare and Medicaid. …

… Trump said his plan for replacing most aspects of Obama’s health-care law is all but finished. Although he was coy about its details — “lower numbers, much lower deductibles” — he said he is ready to unveil it alongside Ryan and Senate Majority Leader Mitch McConnell (R-Ky.).

“It’s very much formulated down to the final strokes. We haven’t put it in quite yet but we’re going to be doing it soon,” Trump said. He noted that he is waiting for his nominee for secretary of health and human services, Rep. Tom Price (R-Ga.), to be confirmed. That decision rests with the Senate Finance Committee, which hasn’t scheduled a hearing.

Since he mentioned Tom Price here, one suspects that if there is an actual Trump plan, it’s Tom Price’s. So let’s look at that. Here is what Price has proposed:

1. Get rid of the insurance exchanges and their subsidies. Instead, offer fixed tax credits to help people buy insurance on the private market.

Those tax credits would be fairly modest, ranging from $1,200 a year for people 18 to 35 years of age to $3,000 for those 51 and older. In many regions of the country, that would hardly begin to cover the premiums and out-of-pocket costs for a relatively comprehensive health insurance plan.

2. Insurance companies cannot deny insurance to people with pre-existing conditions provided they been insured continuously for the previous 18 months. If you lose coverage because you can’t make a payment, too bad. No insurance for you.

3. “Expanded” health savings accounts. HSAs are great for young, healthy people who need tax shelters; not so much for anybody else.

4. There would be taxpayer funded high-risk pools for sick people who can’t get insurance. These have been tried in the past and have proved to be bottomless money pits. I’m sure the insurance companies like this idea, though, because it lets them off the hook for insuring really sick people.

Price appears to be seriously low-balling the scope of the problem by proposing to invest a mere $3 billion into state risk pools over a three-year period. Ryan’s “Better Way” plan, for instance, would provide $25 billion over the coming decade, and even that might prove to be woefully inadequate.

5. Price wants to limit the employer tax exclusion for providing health insurance to $8,000 a year for individual policies and $20,000 for families. I suspect people would see their employee benefit health insurance taking bigger bites out of their paychecks.

6. Able-bodied single people would no longer be eligible for Medicaid, no matter how poor they are.

7. Price wants to allow insurance companies to sell insurance across state lines. Republicans are in love with this idea because they think that the competition would force insurance premiums to go down. Nobody who understands the health insurance industry thinks this would work.  See also articles in The Fiscal Times, Forbes, and the New York Times explaining why this is a dumb idea.

What Trump probably will propose is a system that would in theory allow anybody to get insurance, but in practice probably would leave out most or all of the people who gained insurance under the ACA, and more beside. Paul Ryan and other Republicans like to make speeches about giving people “universal access” to health insurance, instead of universal insurance coverage, which I interpret to mean “you can buy all the insurance you want, as long as you can pay for it.” Which, of course, is the catch.

But Trump specifically said,

“We’re going to have insurance for everybody,” Trump told the Washington Post. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

He’s either lying or he doesn’t know what he’s talking about. Of course, both might be true. You either stick with some version of the ACA, or go with a single payer/national health care plan, or throw people into the private insurance market to sink or swim. There really aren’t any other options. Tom Price’s ideas won’t work to make health insurance affordable or  reduce health care costs. Health care costs are the real cause of high premiums, and health care costs are high in the U.S. because we have a for-profit system that allows for rampant price gouging.

The part about allowing Medicare to negotiate drug prices is something Republicans have fought tooth and nail since Part D was established in 2003. (Medicaid already allows for some negotiation.) President Obama tried to tweak the Medicare system a bit to allow for some negotiation, but Republicans balked at that, too. Part D is a cash cow for the pharmaceutical industry, and those lobbyists aren’t going down without a fight. Trump will be in for a fight from his own party on that one.

(I have to crab about Democrats, too, however. Recently Bernie Sanders introduced an amendment that would have allowed importation of cheaper drugs from other countries. This had enough Republican votes it would have passed, except that a gang of Democrats voted against it.)

 

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22 Comments

  1. Stella  •  Jan 16, 2017 @4:09 pm

    I say if the French can do it, why can’t we?

  2. moonbat  •  Jan 16, 2017 @5:13 pm

    I encourage you to step back and see the bigger picture –

    – in Forbes (of all places; via Digby) What The Trump Era Will Feel Like: Clues From Populist Regimes Around The World

    this article references an earlier article in the WaPo

    I watched a populist leader rise in my country [Hungary]. That’s why I’m genuinely worried for America.

    Some money quotes:

    “Populists govern by swapping issues, as opposed to resolving them. Purposeful randomness, constant ambush, relentless slaloming and red herrings dropped all around are the new normal. Their favorite means of communication is provoking conflict. They do not mind being hated. Their two basic postures of “defending” and “triumphing”

    …Keep in mind, though, the Hungarian’s warning above: there is no plan to resolve such issues, merely to keep them active and inflammatory. The aim is to keep it all on the boil, crisis merging into crisis, with the strong leader dominating and stoking the noise. There will be something fresh everyday from Monica Crowley’s plagiarism to the fashion choices of the first lady. Behind the noise, there will be only more noise. Some demagogic quasi-successes will be paraded but paradoxically they won’t illustrate real policy directions. Confusion is the policy.

    …For the best guide to the garish sensory wall-paper of the Trump era’s assault on our senses we must look to RT and other Russian news media. They pioneered post-fact reality as mainstream culture. Peter Pomeranzev’s book Nothing Is True, Everything Is Possible studies the phenomenon, and lays it out plainly. In essence, the kind of supermarket gossip-tabloid material that once infested our peripheral vision now moves front and center. Total fantasy – for the masses. Every so often containing a tiny germ of truth. Total fantasy and not even simple lies like Kellyanne Conway’s recent assertion that the intelligence services clearly concluded Russia hadn’t successfully influenced the election. (They concluded no such thing.) Or Trump’s notorious assertion months ago that Mexico’s President, after their meeting, had agreed to pay for the wall. It will feel more like a wholly fabricated unending theater of bizarrerie and Orwellian inversions. As Michael Hirschorn says in the MSNBC interview, we look for the wrong things in Trump’s world, such as content and argument. “In reality TV it really isn’t about content, it’s about show, about performance…it’s about endless chaos.”

    Bringing it back to Trump’s promise of a pony:

    For a long while, Trump will ignore his more-or-less respectable cabinet chiefs and get things done via non-accredited unofficial advisors. Picking through the legal minefield, the courts and ultimately the Supreme Court will be very busy. So, think about vacancies on the Supreme Court. Watch Republicans in Congress divide endlessly over the issues. There will be incessant all-against-all confusion in America’s institutions – as there was in the very process of the election. All this chaos – cui bono? Confusion and uncertainty creates a yearning for strongman rule.

  3. c u n d gulag  •  Jan 16, 2017 @5:19 pm

    PPACA – aka: Obamacare – is the best we can do when politicians (or at least ones from one party in the political system) make a Rube Goldberg like hodge-podge contraption which is a combo of private and goverment directed health insurance.

    For one thing, the Republicans were against WHATEVER came from President Obama and the Democrats.
    And they spent the year or so while the PPACA bill was being passed, throwing steel shards and rocks into the gears.
    In other words, if it had to pass, it would pass with a ton of potential future problems and issues.

    Then, as the bill was being debated, with the help of the Koch Brothers sponsored “Tea Party” protests, the Republicans vowed that when they were back in power, they’d “REPEAL” the bill. All to the cheers from their sycophantic, Obama loathing, followers.
    But then, came the cries to “replace,’ when people started liking what first trickled-out when the bill was passed: young people covered under their parents health insurance until age 26, no lifetime caps, and no excluding people based on prior conditions.

    In the meantime, SCOTUS CJ Roberts decided to complicate things even further, by not allowing Medicaid coverage across all 50 states. He left the option open to Republicans Governors and state legislatures, which they used to stick up their middle-fingers, and shout a resounding “F-U!!!” to Obama and the Democrats.

    The Republicans/conservatives have had 7+ years to come-up with a replacement. And they couldn’t do it.
    So, is t-RUMP lying? Almost 100% likely. He’s known for saying whatever’s easiest on him at that moment.

    And this puts his fellow Republicans in Congress between a rock and a hard place.
    They now have to cobble something together that looks like it’ll “replace” Obamacare – and all they’re prepared to do, is only “REPEAL!!!”

    I suggest they “Repeal, and Rename!”
    Call it t-RUMPcare, or whatever. Fix what needs to be fixed – somthing they’ve been denying President Obama and the Democrats to accomplish.
    “Repeal, and Rename!”
    Our fellow Murkins have the memories of fruit flies. So, they’ll never figure it out if you have a lost of noise, balloons, and other glitzy shit companies use when they’re launching or relaunching something “NEW!”

    “Repeal, and Rename!”

  4. Bill Bush  •  Jan 16, 2017 @5:35 pm

    Sounds like to me they could have enough different little parts of this thing to continue distracting and changing topics in the face of criticism. That sort of medicine show barker stunt has worked for Trump and the R’s so far.

  5. aj  •  Jan 16, 2017 @6:43 pm

    savings accounts, really?
    no aca minus 20 million
    no expanded Medicaid, minus 10 million
    insurance across state lines? so when they pay zero you can’t even complain to your state ins commissioner
    After reading trump’s everything’s gonna be great language, I started to say:” it’s only 19.99 and wait there’s more…” why are americans falling all over themselves for a con?

  6. Swami  •  Jan 16, 2017 @7:12 pm

    Don’t forget that on day one Law and Order is coming to the land. The anticipation is killing me!

  7. paradoctor  •  Jan 16, 2017 @8:20 pm

    My wife and I tried a health savings account this year, and soon learned to despise that particular company. They followed the Ferengi First Rule of Acquisition: Once You Have Their Money, You Never Give It Back.

  8. Doug  •  Jan 16, 2017 @10:05 pm

    Tom Price is guilty of insider trading. Will it be enough to derail his appointment? No, I’m not betting on it, but combined with Crowly bowing out for plagiarism. Puzder may be wavering – he’s getting heat that he’s not used to. SO the cabinet and ethics situation is flaky possibly on the way to a blizzard. Worst of all Trump, there’s a report that the alt-right isn’t happy with Trump. Pass the popcorn.

    IMO, Trump and Ryan are entirely strategizing the blame game. Nobody can deliver on all the promises made. SO who takes the heat for promises broken? The GOP can (and I think will) pull the plug through reconciliation. Eight democrats have to sign on to any ‘replace’ legislation. It won’t happen unless republicans ACTUALLY craft something that will cover 20 million people who will get dumped by repeal.

    So we aren’t going to see republican ‘replace’ passed for the same reason we won’t have faster-than-light travel. Nobody’s invented the drive that will do it – and health care costs money that poor people don’t have – ‘free’ health care or market-based health solutions are as mythical as warp drive.

    This is all a dog and pony show for the rubes, like designing a colony for a planet we can’t reach. The GOP only wants to say it coulda been except for the mean democrats.

    Regardless of the noise made in the House and maneuverings in the Senate, some dems have to support any ‘Replace’ legislation – and I don’t think they will. I think the pain will be soon because the Freedom Caucus believes that the free market fairy will fix all as soon as the government is out of it. So finding ACA past 2017 is unlikely.

  9. csm  •  Jan 16, 2017 @10:23 pm

    All of these ideas have been vetted, and experts determined that they simply do not work, if the goal is to make health care affordable. Not only will none of it work, its bound to make health care costs rise.

  10. Swami  •  Jan 17, 2017 @1:57 am

    The only problem with Trump giving me a pony is that zoning restrictions prohibit me from housing it on my property. I can’t afford to keep it.

  11. bernie  •  Jan 17, 2017 @8:16 am

    Swami, you will get your pony, just wait.  You will get to pony up for a faux gold plated bed pan on a future visit to some medical facility.  This product will be deemed necessary for proper treatment by faux research and available only from one supplier.  Competition will be curtailed by federal regulation and prohibitions on imports.  If you survive your stay you get to take your bed pan with you, as they cannot be reused by federal regulation.  The bed pan will bear the proud logo of small hands industries and be made in America by non-union workers. 

    Stella has the right idea.  Find a country that knows what they are doing and follow what they do.  Perhaps we can just outsource the whole thing to Canada, at least for those within commuting distance.  It is fairly obvious that this country is only a leader in making health care expensive and of course collecting copays.  These are not features envied by the rest of the world. 

  12. c u n d gulag  •  Jan 17, 2017 @9:13 am

    Swami,
    Just because there’ll be piles of horseshit all over your property, don’t make the mistake of assuming t-RUMP left you a pony.

    He just needs places to discard the ever increasing amounts of horseshit that’s coming out of his grain-sized brain, and gaping maw of a jow!

  13. c u n d gulag  •  Jan 17, 2017 @9:14 am

    “jaw,” of course – not jow…

  14. goatherd  •  Jan 17, 2017 @2:06 pm

    Swami, I think Paul Ryan has already anticipated and fixed the zoning problem. You’ll be getting a pony voucher. I hear it’s “suitable for framing,” at least so far.

  15. Swami  •  Jan 17, 2017 @2:42 pm

    In the crazy world of inverse psychology I would guess that Trump’s legitimacy as President is taking a hit when Vlad makes himself available to be a character reference for Trump. Why would Putin come to the defense of Trump’s domestic squabbles knowing that to do so would only cast suspicion on the dynamics of that relationship?
    From my eyes it appears that Putin’s got a dog in the fight. What kind of a man would sell out their country in exchange for some cheap praise? Maybe a sociopath who can’t form an allegiance to anybody other than himself and has an ego that’s driven by the constant need for adulation. Sound like anybody ya know?

  16. Swami  •  Jan 17, 2017 @3:04 pm

    goatherd..I’m not up on understanding how this pony voucher works. Is it like plaid stamps where I can redeem it for other merchandise if you don’t want the pony? Or does it have a par value payable in cash? I certainly don’t want a pony. I hear that they can be quite expensive to care for. My best bet would be to just frame my voucher like you suggest, and place it next to my Cold War certificate.

  17. LongHairedWeirdo  •  Jan 17, 2017 @3:46 pm

    Republicans are in love with this idea because they think that the competition would force insurance premiums to go down.

    Do you mean Republican rank and file, or Republican policy-makers? The policy makers are, I think, fully aware of selling-across-state-lines is just a gift to the insurance industry – find the state that has the regulations best for your bottom line, set up office there. I’m not sure if this holds for all important Republicans; you could tell me that Inhofe thinks that this is a great idea to lower costs, and I’d believe you – but you could tell me that Inhofe believes that Bob Dylan’s voice was his strongest asset, and I’d believe you. I don’t want to insult a box of rocks, so I won’t use the obvious comparison.

    I do think that the Republican rank and file believe that this will create competition because that’s the talking point that gets trotted out. And if Very Serious People repeat a statement often enough, people assume it must be researched and supported

    I wouldn’t be surprised to learn that Republican Loudmouths are for it because liberal elites are against it. That every sensible human being (in addition to the amorphous “liberal elites”) is against it doesn’t matter as much as sticking it to the liberals.

  18. Swami  •  Jan 17, 2017 @5:28 pm

    Is this some of that fake news I’ve been hearing so much about?
    https://www.yahoo.com/news/18-million-could-lose-insurance-under-obamacare-repeal-175514484.html

  19. paradoctor  •  Jan 17, 2017 @8:11 pm

    Stella: If the French can do single-payer, why not us?
    Because France is post-imperial. One of the curses of empire is that they tend to get stuck on stupid. The point of power is to defy the truth, not obey it.

  20. goatherd  •  Jan 18, 2017 @8:57 am

    Paradoctor, I am sure Vagabonde or someone who is more intimate with the French language and healthcare system could correct my errors or supply more details. But, as we were considering relocating, I took a look at the French system.

    I think you could describe it as a kind of non-profit insurance company, rather than single payer. They pay into the system as we do for Medicare, and when they go to to a doctor or receive medical care, they generally pay up front and are reimbursed. If you move there as a resident, you have to buy insurance, but you are eligible to join the French system after five years.

    As I probably mentioned before, I have first hand experience with the French system and medical tourism. Even if you are paying out of pocket, the cost of medical procedures is far cheaper in France. Without going into too much detail. If you compare the cost of a moderately costly procedure here in the US with the cost in France, one could, pay for the procedure, spend a week in Paris, a week in Lyon and a week in Provence, and still do better than break even. I know because I did it.

    There are probably a lot of reasons for the relative affordability and effectiveness of the French system. If I had to guess with my limited knowledge, I’d say, far more people are insured or have medical costs provided, so the cost of unpaid care isn’t distributed over the cost of care to those with insurance; doctors probably don’t have to shell out so much for malpractice insurance; the care is provided in a more efficient and simpler way.

    These elements come together at times. Let’s say for example, that a baby is born and develops severe neurological damage. The parents are faced with a cost of a few million dollars in healthcare over the course of their child’s life. Frequently, they are unable to pay. So, a lawsuit is their only recourse, and a jury is very likely to find against the service provider, irrespective of whether or not they are at fault, because they are insured and they are the only one with deep pockets. In civilized countries with universal health care, this is not the case.

    We used a clinic in Lyon. The rooms were simple, with a summer camp feel. Weather permitting, the windows were open, which is effective infection control and the preparation and procedure were achieved with effective simplicity. My wife, who is a midlevel service provider, was very impressed.

    However, Paradoctor, puts it well. Why can’t we ever admit that someone else has found a better way?

    Oh, I guess because sometimes the better way doesn’t involve big profits for business, the magic of the free market, privatization or tax incentives. What was I thinking?

    In the Randian Promised Land, the promises don’t ever seem to be fulfilled.

  21. bernie  •  Jan 18, 2017 @11:24 am

    Maybe you consider Chinese saying: “people with petty shrewdness attend to trivial matters, while people with vision attend to governance of institutions.”

  22. maha  •  Jan 18, 2017 @12:57 pm

    bernie — “people with petty shrewdness attend to trivial matters” — I had never heard that one before, but “petty shrewdness” pretty much explains Trump. I remember thinking of Mitt Romney that (especially compared to President Obama) he was shrewd but not intelligent, meaning that Romney is obviously very good at nuts-and-bolts type thinking and of figuring out ways to maximize profit — not my strong suit, alas — but he’s not an original thinker. He’s not one who can come up with fresh insights or perceive how disparate things might be interconnected. But compared to Trump, Romney is a genius.

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