Donald Trump’s Healthcare Problem

Screen Shot 2016-02-23 at 12.05.28 PMWhether you are elated, appalled, or just plain amazed that Donald Trump is the Republican primary front runner by a considerable margin, one thing should be clear: he’s not a policy guy.

So far, The Donald’s lack of policy specifics seems not to have hurt him. He’s successfully deflected the more searching debate questions, provided vague generalizations or given incomprehensible responses, and—when all else failed—insulted the debate moderators or his fellow Republican candidates.

So far, so good, for the Trump campaign. But is it time to change tactics?

As the number of competing candidates dwindles(So long, Jeb!),the focus in debates and interviews becomes sharper. With the original crowded field winnowed to just a handful,interviewers and debate moderators have time to probe a lot more deeply.And even if the questioners are relatively gentle, every other surviving candidate will be eager to pour scorn on policy statements that lack either substance or rationality.

Like Donald Trump’s healthcare proposals so far.

He’s said he wants the government to negotiate Medicare drug prices, he likes health savings accounts, he wants to be able to buy insurance across state lines, and he wouldn’t cut Medicare. And that’s pretty much it, except for one very big thing: he would “repeal and replace” Obamacare. But by what? “Something terrific” he says.

It’s easy to mock, but all of us – liberals and conservatives — should worry that we might just find ourselves with an incoming president trying to impose such an incoherent healthcare vision that our present system would look like a paragon of rationality.

So, maybe it’s in all our interests that Donald Trump should have a healthcare policy that’s more intelligible than he’s offered so far(nicely satirized by Ian Morrison in a recent THCB post). It would presumably have to be one with conservative appeal, be understandable by the average voter, be different from other candidates’ proposals, and play to Donald Trump’s biggest strength: he’s a successful businessman, not a politician.

In the hope that Donald Trump is able to develop a more coherent policy, imagine this debate exchange:

Megyn Kelly: On behalf of Fox News, welcome to the twenty-fifth Republican presidential primary debate. Nice to see you again, Mr. Trump. Tell us about your plans for American healthcare. You have said you will replace Obamacare by “something terrific”?

Donald Trump: I’m gonna to do it as soon as I’m in the White House door.

MK: Go on.

DT: I’m gonna make the whole thing work like a business. The same way my hotels are a business. We’re gonna save big bucks by having proper competition, just like in the hotel business. I’ll tell ya, if hotel rates had gone up like healthcare costs, I’d be a trillionaire not just a billionaire. What we’re gonna do, we’re gonna let every American choose what insurance to buy, just like they can decide where to stay to get the best deal. And we’re gonna do it with a lot less government interference.

MK: How’s that going to work?

DT: See, we’ll give everyone a voucher that they use to buy the insurance they want. Just like they can choose a superior Trump brand resort or a crummy Motel 6.

MK: Why would anyone choose the Motel 6 option for their health insurance?

DT: The voucher will cover the Motel 6 costs, but people are gonna have to use some of their own cash if they want a superior brand. Like mine.

MK: So, back to healthcare, there’ll be more competition between insurers. But isn’t there competition today?

DT: Nah, not really. Most insurance is bought by employers who only want to keep their [bleep] unions happy. If regular people had to use their own cash to get anything more than Motel 6 insurance they’d buy only what they need, for a lot less money. But everyone would have insurance, like I’ve always said.

MK: Where would the funding for the vouchers come from? This is beginning to sound like Senator Sanders’ Medicare for All proposal.

DT: That Bernie! Well-meaning guy, but he’d bankrupt us all with new taxes. I’ll tell ya where the money for my plan would come from. We’ll end this deal where some people get insurance for free from their employers and others don’t get anything. Companies shouldn’t be in the insurance business anyway. Aetna doesn’t build airplanes, so why should Boeing provide insurance? That’s nuts. We’ll get rid of monopolies. We’ll get rid of Medicaid, won’t need it anymore. We’ll get rid of a zillion bureaucrats. And we’ll use vouchers to make Medicare competitive, too. And we’ll do it with no new taxes.

MK: So, you’ll turn the whole healthcare system over to the insurance industry?

DT: There’s gonna have to be a few rules, so they can’t gang up, but we’re gonna make them compete. Just like hotels compete. My way for healthcare, it’s how businesses made America great, and it’s gonna make America great again.

Senator Cruz (interrupting): Giving everyone insurance coverage is communism! Remember what the Bible says: “For whoever has, to him more shall be given, and he will have an abundance; but whoever does not have, even what he has shall be taken away from him.”  That’s the Republican way!

Senator Rubio: Amen!

Well, it’s only an imaginary debate segment. But it’s better than Donald Trump has produced so far.

Roger Collier is the founder of the Campaign for a Rational Healthcare System (www.rational-healthcare.com). He was formerly CEO of a national healthcare consulting firm.

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20 replies »

  1. Mr. President over and again promised to nullify Obamacare and supplant it with a Republican option that would give “protection for everyone” at a lower value—an apparently unthinkable administrative errand that the president handed down to Congress. On Monday night, House Republicans discharged their hotly anticipated first draft for Trumpcare, a 123-page charge that would cover less individuals, enable safety net providers to offer lower-quality protection, and drastically raise costs for poor people. The essential recipients of the arrangement seem, by all accounts, to be individuals from the working class, who may get a bigger assessment credit, and the rich, who might appreciate a sizable tax break.

  2. “Trump is a great performer.”

    If one’s taste’s run to the WWF or Jersey Shore.

    Seriously, MOST of what he brashly claims he will do (to the extent there’s any actual detail) is outside of the Constitutional scope of the Executive Branch. Running the U.S. Government is not the same as being an autocratic CEO of a private corporation. For one thing, there are 535 equally large, turf-protective egos on the Hill alone.

    Were his name “Saddam” we’d be working to overthrow him, not elect him.

  3. Trump is a great performer. He is charismatic and know how to say the right words
    usually by repeating over and over again the same words. But when you get elected as a president, reality strikes. I don’t think there will be any major changes in the healthcare system.

  4. See “The American Health Care Paradox: Why Spending More is Getting Us Less”

    Interesting comparisons to other comparable nations’ systems. From the Amazon blurb:

    “For decades, experts have puzzled over why the US spends more on health care but suffers poorer outcomes than other industrialized nations. Now Elizabeth H. Bradley and Lauren A. Taylor marshal extensive research, including a comparative study of health care data from thirty countries, and get to the root of this paradox: We’ve left out of our tally the most impactful expenditures countries make to improve the health of their populations—investments in social services.

    In The American Health Care Paradox, Bradley and Taylor illuminate how narrow definitions of “health care,” archaic divisions in the distribution of health and social services, and our allergy to government programs combine to create needless suffering in individual lives, even as health care spending continues to soar. They show us how and why the US health care “system” developed as it did; examine the constraints on, and possibilities for, reform; and profile inspiring new initiatives from around the world.

    Offering a unique and clarifying perspective on the problems the Affordable Care Act won’t solve, this book also points a new way forward.”

  5. As much of a buffoon as Trump is does any candidate on either side really know how to “fix” healthcare? Bernie gets closest but he’s not selling the cost/benefit very well for people to grasp the reality of his vision.

    Of course with most people getting their coverage (no matter how bad or expensive) from their employer, fear of getting something even worse is a big hurdle for Bernie.

    Just have to say that Tump is the natural outcome of a dysfunctional Republican Party and the bigger political system which Mitch McConnell helped engineer.

    But if people think times are bad with government just let them try life without it – there’s a bunch of third world countries that will serve as example.

  6. Yeah. GOP needs ~40% of Hispanics in the General (beyond the black vote consideration). Trump® is polling at 13% or so there (General, not primaries).

  7. Republicans are irrelevant, net, in the General. What matters is the aggregation of Democrats and Independents.

    One scenario I’ve thought of: Hillary and Bernie fight it out through the primaries, she prevails, offers him VP, he agrees (after having extracted significant concessions). He could essentially stay in the Senate, where he know the ropes. He shores up the left…

    Game.Set.Match. A total national smackdown that could make the poignant Biff Romney crash & burn look like a nail-biter.

  8. Are we arguing that 40% of Republicans will vote for Hillary Clinton rather than Trump?

    Or that they’ll sit this one out?

    Either scenario seems unlikely!

  9. Trump is performance art. And very good performance art, as it is. But look at the data. At least 40% of Republicans won’t vote for him and if he carries super Tuesday next week, he’s going to be the nominee. And that will bring the biggest Hispanic turnout ever, allied with Clinton’s husband’s roots in the African-American community. This will be a laugher for the Democrats–which is why the mainstream Republicans have no idea what to do!

    The only problem is that we have to listen to another 9 months of this bombast

  10. It’s their blog, they can post whatever they wish. And front-runner Trump’s utterly shallow views on health care policy are fair game.

  11. I think he is a sort of seizure in the body politic and helps us reset some of our thinking. I’m not sure if he can think….e.g. imagine a functional health care system and describe most of its parts–without hollering and finger-pointing at shibboleths. But, maybe he can….we’ll see.

    He could be worse: he could be boring. He could be bought.

  12. I agree that its fair criticism, but I think it was very funny and inventive. Trump really does lack policy in almost every area except superficial policy inventions that sometimes change 180 degrees. I don’t think any other candidate is quite like Trump in that matter so I appreciate the authors writing skills and am glad he posted it.

    I hope he does a similar one on Hillary.

  13. That’s fair criticism- for the record we have posts coming on Clinton, Sanders and other candidates. THCB runs opinion pieces on all sides of the political spectrum – Mr. Trump elicits strong opinions

  14. You should not air your political opinions. I have not seen you mention specifics from the other candidates views on healthcare, why did you focus on Trump and not ALL the candidates? Poor use of Blog, shame, if you are going to air political thoughts, cover all the candidates. This should not be a venue for political views!!

  15. I was surprised that an article by someone heading up the Campaign for a Rational Healthcare System did not carry the byline of Don Quixote de la Mancha. In any event the best comment I’ve seen on Mr. Trump’s “competitive bidding” proposal for Medicare is that he promises to save $350 billion a year on the cost of Medicare drugs — and the total cost is roughly $78 billion. Another journalist searched for signs of any health care experts giving Mr. Trump advice on health care and (surprise) found none. While I, too, long for rationality, “Willing Suspension of Disbelief” apparently has a lot of votes on both sides of the aisle this year.

    In any event, given Mr. Trump’s extravagant promises in other hot-button issues (no Muslims, deporting 12 million immigrants), healthcare is the least of his problems.

  16. In a nation of ~250 million voting age adults, roughly 16% of them will be minus one standard deviation or lower on the IQ scale bell curve. That’s roughly 40,000,000 not-so-bright people. Roughly 5%, or 12 million of them will be -TWO standard deviations or lower. This loud, angry cohort disproportionately comprises Donald Trump’s base. They are the low-hanging fruit of the demagogue. Trump plays them like a fiddle, given that they are so easy to rile up. They never give the first moment’s reflective thought that MOST of what Donald Trump says he will do he would not have the authority to do as President. The US President is not the CEO of a private corporation.

    A lot of people are getting played.

  17. It’s actually a hell of a lot worse. And since Mr. Trump is not running to service the “donor & lobbyist” class, I don’t think the above pure conservative establishment dogma is ever going to get implemented if (big if) he gets elected. Which is a very good thing, in my view.