Sunday, March 06, 2016

Donald Trump's Healthcare Plan is Donald-Trump-Level Crazy

Here we go folks: Donald Trump's got a health care plan! Or as Trump of course puts it, "Healthcare Reform to Make America Great Again." He'd like to repeal the 2010 Affordable Care Act, which he claims, "has tragically but predictably resulted in runaway costs, websites that don’t work, greater rationing of care, higher premiums, less competition and fewer choices. Obamacare has raised the economic uncertainty of every single person residing in this country."

As is usual with Trump, just take the exact opposite of what he says and you'll have a good reflection of reality. The average annual increase in health care costs is down substantially under the ACA, and the law is reducing the federal deficit. The health care exchanges are working fine and meeting their signup goals. The law does not ration care. People have a choice of insurance; before the law many with pre-existing conditions had no choice, or insurance, at all. And the 17 million people who gained health insurance thanks to the law through May of 2015 now have a lot less economic uncertainty, given that they no longer have to fear that a single hospital visit may bankrupt them.

Here's what Trump's got for us:

1. Repeal the individual mandate. Now Trump is known for his contradicting himself on the issues, but this is a big flip-flop even for him. Just last month in a Republican debate he said, "I like the mandate." Two problems with repealing the mandate. One, if folks are no longer required to have insurance, we'll go back to the old system where taxpayers picked up the tab for the uninsured to get all their health care in emergency rooms. Two, without the mandate premiums would skyrocket as some healthier people left the risk pools.

2. "Modify existing law that inhibits the sale of health insurance across state lines." Every time one of my conservative friends rails against Obamacare, and I ask them, OK, how would you insure the uninsured, they say, "Allow insurance companies to sell across state lines."

First of all, here's some news for Republicans: insurance companies are already allowed to sell across state lines. They don't do it because it's not a workable system. As Senator Al Franken explained recently:

"Why? Because a license to sell insurance in a given state isn't the only thing insurance companies need in order to be able to actually sell insurance. They need to learn the state, analyze the healthcare needs of its population, recruit participants, build a network of providers, negotiate rates, and more.

"If you're a huge insurance company like Blue Cross, you might have the resources to replicate this effort in states across the country, which is why you can get Blue Cross insurance in multiple states. But smaller insurance companies based in a single state have found again and again that, even when offered the opportunity to sell across state lines, it simply isn't worth the hassle."

To put it another way, from Margot Sanger-Katz of the New York Times,

"The trouble is that varying or numerous state regulations aren’t the main reason insurance markets tend to be uncompetitive. Selling insurance in a new region or state takes more than just getting a license and including all the locally required benefits. It also involves setting up favorable contracts with doctors and hospitals so that customers will be able to get access to health care. Establishing those networks of health care providers can be hard for new market entrants."

Or to put it still another way, From John R. Graham of the Hill,

"Absent Obamacare, states had dramatically different health insurance mandates. As a result, New Yorkers paid more for insurance than did Utahans. Therefore, the argument goes, if Congress passed a law allowing New Yorkers to buy policies licensed in Utah, they could buy less expensive coverage. Well, maybe they could, if they wanted to fly to Salt Lake City every time they wanted to see a doctor or needed an operation."

3. "Allow individuals to fully deduct health insurance premium payments from their tax returns". I'm going to go with the snarkiest comment I can find on this one. From Kaili Joy Gray of,

"Nothing treats cancer better than tax deductions for rich people, who are the people who benefit the most from tax deductions and don’t help low-income people, like, at all. But as we know, when it comes to Republican policy, that’s the point. And really, don’t poors prefer a healthcare system that lets riches take bigger deductions instead of one that provides subsidies for healthcare coverage for those folks who really do need the savings? That’s rhetorical. Don’t bother answering."

4. "Allow individuals to use Health Savings Accounts (HSAs)". Earth to Donald: They already can.

5. Block-grant Medicaid to the states. Yeah, real bad idea. From Kevin Drum of Mother Jones, 

"This would accomplish nothing except, probably, to make health care worse. States tend to do everything they can to use Medicaid dollars for non-health purposes, and giving them total control over Medicaid would only make this worse. Also, it would eliminate the automatic increase in Medicaid spending during recessions, when it's needed most. Overall, this proposal would almost certainly result in less Medicaid spending and less effective Medicaid spending."
6. Allow drug "importation." Trump's web site doesn't really explain what he's talking about. Furthermore, our prescription drugs are already imported from overseas manufacturers. What Trump is referring to is buying drugs from other countries who had already purchased them from drug companies at lower prices. From the Motley Fool,

"In America, Medicare can't negotiate for lower prices directly with drugmakers and insurers must negotiate prices with drugmakers individually. As a result, Americans can pay far more for their medicine than people living in other countries. For example, prices for a medicine in Canada can be less than half the price charged for the same drug in the United States."

"Under Trump, a system for importing drugs would be created that helps consumers import medicine from markets such as Canada."

Several problems with this. First, The US Food and Drug Administration requires that drug companies implement track and trace systems to guarantee the security of prescription drugs to customers. Counterfeit drugs are a major problem and accounted for $75 billion in revenue in 2010 according to the National Association of Boards of Pharmacy. All the way back in 2004, Republican Senators released two prescription drug importation reports by the U.S. Departments of Commerce and Health and Human Services (HHS) which rejected, "any lingering hope that the individual importation of pharmaceuticals is – or can be made – safe and reliable for personal use. There is simply no amount of resources that can guarantee that the content and quality of foreign prescription drugs purchased via the Internet, mail order, or other such means are safe for patients to consume."

Second, again from the Motley Fool, "Because America is a large and highly profitable market for drugmakers, medicine is often launched in the U.S. first, and therefore, new medicines or complex specialty medicines may not be available for import for months or even years after they've become available in America."

Finally, if Mr. Trump would like to solve the problem of high drug prices in the US, there's an easy way to do it: change the law so that Medicare CAN negotiate prices.

There is however one part of the Trump plan I can recommend: "we need to reform our mental health programs and institutions in this country." Indeed, I can think of a certain Presidential candidate who could benefit from said services.


Gowri Sharma said...

Inspiring writings and I greatly admired what you have to say , I hope you continue to provide new ideas for us all and greetings success always for you..Keep update more information..

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M. Joseph Goodfriend said...

Nice to meet you Gowri, thank you for the comments. The Trumpcare bill that's moving forward in Congress is making me very sad, and I can use all the positive thinking I can get. Peace, Joe