The Donald Effect

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No one knows how Donald Trump’s meteoric rise to the top of the GOP primary race ends, its impact on Campaign 2016 or its domestic and foreign policy implications for the U.S. will play out. What we know is the man knows how to get a crowd, spark discussion, and steal media attention from his 16 GOP primary rivals. He has built his brand as a straight shooter on tough issues and unapologetic foil of political correctness.

Friday night, the Donald show flew into Mobile, AL, and lit up a crowd estimated at 20,000 at the University of South Alabama football stadium. He left town on Trump Air dominating the weekend’s media coverage, perplexing the pundits who were betting the Donald show would flame out.

Political theatre is prone to big stories like “the Donald”. He’s brash, cocky and unfiltered as he talks about dicey issues. He has simple solutions to immigration reform and the threat of ISIS. He promises to be a tough commander in chief in war zones and fierce negotiator in trade pacts. Healthcare is on his list as well.

Friday night, he promised to “repeal and replace” the Affordable Care Act. He called out insurers: “The biggest beneficiaries of Obamacare are the insurance companies… the insurance companies love it. They are so protected; they are making a fortune. We are going to end that – we are going to get so competitive by getting rid of the artificial barriers…Just take a look at your premiums, your deductibles – they’re so high it’s impossible.” He’s on record saying the U.S. health system is the best in the world, needs less government intrusion and more free market-driven reform. End of story. Then he moved on to other issues and pitched his book, The Art of the Deal, unashamed. His teleprompter-less straight talk and the stadium fly-over by Trump Air reflect the uncanny showmanship the Donald is bringing to Campaign 2016.

But what if he had spent more time on healthcare Friday night? What if he had zeroed in on healthcare in Mobile? It’s a market where big players dominate and consumer choice is limited. There’s one major plan – Blue Cross of Alabama, and two major health systems, Providence and Mobile Infirmary. Utilization is high, health status is poor, and premiums are above the state’s average and going up.

In vintage Trump-speak, he might have said “You’re stupid. You’re the problem: You are not very healthy and it’s costing you. And your community isn’t doing anything to fix it. That’s why your premiums are going up. That’s why you have more doctors and beds than you need. You’re the problem..”

Might those cheers suddenly become jeers? Probably.

The fact is that communities like Mobile are more the rule than exception. Data show that a community’s health– how its employers, payers, community leaders and providers address the healthiness of their citizens– is key to lower costs and better health. With due deference to efforts like accountable care organizations, bundled payments, and shared risk arrangements with payers, it takes a community to reform healthcare.

So if Mobile’s a stage for fixing healthcare, the issue of community health must be on the table. In some communities, these efforts are underway; in most communities, these efforts are modest if at all.

Even the Donald might be challenged to bring straight talk to healthcare. And straight talk about healthcare requires serious talk about the community’s role. That could be the Donald effect.

Paul Keckley is managing director of Navigant’s Healthcare practice.


6 replies »

  1. kinda like a guy who was a “community organizer” and voted “present” in the senate for 160 days can create a healthcare plan for 320 million people.

  2. Trump’s entertaining, but so is a wrestling match on WWF. Would you actually want one of those wrestlers as president?

    I thought the insurance industry WAS free enterprise – guess not.

    Not sure a guy who inherited his dad’s real estate empire and went on to go bankrupt a number of times on other peoples money knows much about anything in the real world of middle America.

  3. With MLR rules in place, it would seem that any difference in premiums between Mobile and elsewhere must be attributable mainly to the cost of healthcare and the health status of the population. The local Blue’s high market share is probably not a significant factor.

    Health status is driven largely by personal behavior like smoking, drinking, diet, exercise, etc. as well as socioeconomic status and environmental factors. Healthcare, at least compared to other places, is driven partly by differences in physician practice patterns which may be more aggressive than average in Mobile. I have no idea whether they are or aren’t. I also don’t know how the incidence of poverty in Mobile compares to other places within AL or in other states.

    On the subjects of healthcare and health insurance, as well as other issues, I don’t think Trump has a clue even though he’s rich and went to Wharton. If people support him enough to actually vote for him during the upcoming Republican primaries, I’m afraid the joke will be on us.

  4. it’s hard for policy wonks to believe, but a lot of people don’t care. Polls suggest Trump’s attacks on insurers are going to play well. As will his attacks on Obamacare’s spend.

  5. Policy detail is for the Losers that created this mess. https://twitter.com/BobbyGvegas/status/632252762206539776

    Beyond his crass appeals to Nativism, Trump’s entire media appeal now is based on people wanting to see the drive-by wreckage of “Who Will He Insult TODAY?” I’m not sure how much “legs” that M.O. will have, long-term. It’s getting to be an increasingly small pool of yet-to-be-insulted targets. When he does amble off into “answering” a policy question, it can be painful to witness. e.g., Trump on Iranian nukes (verbatim, video at C-SPAN):

    “Look, having nuclear—my uncle was a great professor and scientist and engineer, Dr. John Trump at MIT; good genes, very good genes, OK, very smart, the Wharton School of Finance, very good, very smart—you know, if you’re a conservative Republican, if I were a liberal, if, like, OK, if I ran as a liberal Democrat, they would say I’m one of the smartest people anywhere in the world—it’s true!—but when you’re a conservative Republican they try—oh, do they do a number—that’s why I always start off: Went to Wharton, was a good student, went there, went there, did this, built a fortune—you know I have to give my like credentials all the time, because we’re a little disadvantaged—but you look at the nuclear deal, the thing that really bothers me—it would have been so easy, and it’s not as important as these lives are (nuclear is powerful; my uncle explained that to me many, many years ago, the power and that was 35 years ago; he would explain the power of what’s going to happen and he was right—who would have thought?), but when you look at what’s going on with the four prisoners—now it used to be three, now it’s four—but when it was three and even now, I would have said it’s all in the messenger; fellas, and it is fellas because, you know, they don’t, they haven’t figured that the women are smarter right now than the men, so, you know, it’s gonna take them about another 150 years—but the Persians are great negotiators, the Iranians are great negotiators, so, and they, they just killed, they just killed us.”