The Rationalist Papers (23): The healthcare plan

Fixing health care is easy.

All you have to do is make the care better, less expensive, and less of a hassle.

That’s the Trump health-care plan in a nutshell. There’s only one problem.

There is no plan.

If you are a person of faith, you know that sometimes you must believe in things when there is no firm evidence that they are true. Such is the case with the Trump healthcare plan.

The difference between a plan and a hope

Donald Trump brought a prop to his interview Lesley Stahl of “60 Minutes” — a binder holding 2,500 pages of Trump health care accomplishments.

Some left-leaning sites have put forth the idea that this book of full of blank pages. It’s obviously not. One person in possession of what he says are the PDFs of this document says it includes passages from the Tax Cuts and Jobs Act of 2017 repealing the individual mandate, along with last month’s executive order and another document called “America First Health Plan.”

You cannot fix the health problems of America with an executive order. It requires legislation. For example, President Clinton put his wife Hillary in charge of creating a healthcare plan for his administration. It never got past the hearing stage. That didn’t count as an advance, since it never was enacted into law.

Trump’s plan never even got to hearings. And there is no strategy from Trump’s administration to negotiate with Congress to pass an actual plan.

You don’t get credit for a big binder. You get credit for making changes.

In September of 2017, with majorities in both the House and Senate, Republicans attempted to repeal the Affordable Care Act, also known as Obamacare. They failed. As Senator John McCain, who voted against the repeal, said at the time:

The so-called ‘skinny repeal’ amendment the Senate voted on today would not accomplish [pricing and care] goals. While the amendment would have repealed some of Obamacare’s most burdensome regulations, it offered no replacement to actually reform our health care system and deliver affordable, quality health care to our citizens.

In fact, Trump has claimed to have the solution to healthcare many times during his term.

  • In 2015, campaigning, he said he would repeal Obamacare and replace it with something terrific.
  • In 2016, he published a blueprint for Healthcare Reform on his campaign site. It was just a set of bullet points.
  • In 2017, his first year in office, Republicans tried and failed to pass several versions of a healthcare plan to replace the Affordable Care Act, culminating in the McCain rejection.
  • In 2018, healthcare wasn’t on the agenda, even though Trump had promised to pass a plan in his first 100 days in office.
  • In 2019, in June, he told ABC News a plan was coming shortly. He repeated the pledge in October. There was no plan.
  • In 2020, in February, May, July, and August, Trump promised plans within weeks. No one has seen them.
  • And now we have the “plan” dropped off with a thud for Lesley Stahl, less than two weeks before the election.

We’re beginning to feel like Charlie Brown trying to kick the football that Lucy keeps jerking away. It takes a level of faith I don’t have to believe that these plans will ever see the light of day, receive hearings in Congress, and pass. Passing legislation takes work. The Trump administration has failed to put in the work.

Trump’s administration has actual healthcare accomplishments. He made it possible for more people to get access to experimental treatments. He expanded access to generic drugs. He directed agencies to take action to improve price transparency (although that effort hasn’t yielded much yet).

But he has also brought suits to end the Affordable Care Act in federal courts, with no actual plan to replace it.

If you believe in the Trump healthcare plan after all this, you are acting on faith, since all the evidence is against you.

We are forgetting what Obamacare brought us

Before Obamacare, unless you were a full-time worker for a company, retired, or poor, there was no health care plan for you. Over 40 million Americans had no coverage.

Before Obamacare, you could get rejected for preexisting conditions like diabetes, back problems, high cholesterol, or even pregnancy. In cases of expensive care, insurance companies would actually dig up evidence of undisclosed preexisting conditions and deny coverage. Obamacare ended that.

Before Obamacare, insurance could include a lifetime cap on your coverage. If your care was expensive — for example, for cancer care — your coverage could run out and you’d be left holding the bag — and going bankrupt.

The Affordable Care Act — Obamacare — is the only thing that makes the gig economy even possible. I make a good living as a freelancer, like many millions of others. I buy my own insurance. Without Obamacare, I’d never be able to get coverage that addresses my actual health needs, because of all of those would be preexisting conditions.

With that said, I find the ACA is extremely flawed.

I pay over $2000 dollars a month to insure my family, along with thousands in copays and deductibles. This is an absurd level of expense.

There is no easy way to see what prices will be, and any visit to the doctor is potentially subject to “surprise” billing from out-of-network professionals.

Doctors I know spend massive amounts of time dealing with insurance paperwork and fighting with insurance companies.

This is a complex problem. The solution lies in reforming it, not just scrapping it and having faith that something better will come along.

Trump has had four years to make progress on this. He failed. Isn’t it time to give someone else a chance?

3 responses to “The Rationalist Papers (23): The healthcare plan

  1. Good post Josh but let’s be clear the answer is Medicare for all. Obama could not get that passed 20 years ago. Being on Medicare myself I clearly see the joke that is the current so called healthcare system. I have same program I had when working FT two years ago and the cost is 3 times less.
    Reform is the answer but the GOP and Trump are totally in bed with insurance industry and big Pharma to keep the costs high. The system is not about health care but about profits for the industry. Sick

    1. There are also Dems in bed with Big Pharma. Here in New Jersey our own Cory Booker has as his top 10 donors local pharmaceutical companies. He led the way in blocking cheaper drug imports from Canada. Obama care which was basically Romneycare2.0 has been a boon to the health insurance industry – they wrote the legislation. We can do better.

  2. Josh, we know Biden doesn’t support Medicare for All. How much do you believe the ACA can be improved without transforming it into M4A?

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