In an interview with 60 Minutes, America’s most-watched television news magazine,Donald Trump, America’s most-watched presidential candidate, basically just promised that he can defy gravity.
I’m not talking about his vow that he could reduce taxes on the middle class — for some people, rates would go down to zero! — and corporations and pay for it by going afterWall Street fat cats and growing the economy. I’ll leave the plausibility of that to others. I’m talking about Trump’s faster treatment of the way he would repeal and replace President Barack Obama’s signature achievement, the Affordable Care Act, or Obamacare.
Trumps assurance, repeated again: he will make sure that every person in the country has health insurance, and will do so in a way that lowers rates for most Americans. And, he claims, he would do this in a way that actually lowers costs over the long term. In order to help the poorest 25% of the population, Trump said, he’d “make a deal with existing hospitals to take care of people.”
Sounds great. Except that’s what Medicaid, the program that already exists to take care of the poor, already does. It drives a hard bargain, and, as a result, 56% of psychiatrists and 40% of orthopedic surgeons don’t accept Medicaid patients. How does Trump expect to drive a harder bargain?
And as for the rest of the market, as my colleague Bruce Japsen writes, Trump is describing something very much like Obamacare, which he says is “a disaster.” Trump’s words: “[I]t’s going to be a private plan and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.”
This is already what’s supposed to be happening with Obamacare. But Trump’s version sounds, well, bigger. The Obamacare exchanges, remember, apply to a small sliver of the insurance market: those people who do not get insurance from their employers and do not qualify for Medicaid or Medicare. Trump seems to be describing a much bigger system where people purchase their own private plans.
We know that he’s a big believer in competition. In a far more detailed description of Trump’s health plan that his campaign gave to Forbes contributor Dan Diamond, Trump placed a great deal of confidence in the idea that getting rid of state barriers to insurance would result in more competition. Actually, as Diamond explained, it might allow insurance companies to evade regulation, because insurers are regulated at the state level.
As Obama did (remember “you can keep your plan”?), Trump ignores the fact that the only way insurers can control costs is to choose which doctors you can go to, which medicines you can take, and where you can get your surgery. That’s what forces hospitals and doctors and drug companies to agree to lower prices: the knowledge that they’ll lose business if they don’t make a deal.
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