health care

On Health Care, the 2020 Presidential Race Pits Bad Ideas Against Bad Faith

Supreme Court Justice Ruth Bader Ginsburg’s death elevates a familiar health care policy dynamic to the foreground of the election.

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Supreme Court Justice Ruth Bader Ginsburg's death last week has thrown the presidential race into chaos. By once again placing health care policy in the foreground of the election, it has unleashed a more familiar political dynamic, in which bad ideas are pitted against bad faith. 

Following Ginsburg's passing, Democratic presidential nominee Joe Biden signaled that he would respond by elevating health policy issues in the race. The Supreme Court is currently scheduled to hear a challenge to Obamacare shortly after the election; a Trump appointee to the court, the argument goes, might be more sympathetic to the challengers than a Biden nominee. The Trump administration, meanwhile, has taken the unusual step of declining to defend the law, arguing that it should be struck down in federal court. 

There's a clear political logic to Biden's move: Polling suggests that the single most effective issue for Democrats in the 2018 midterm election, where they overtook Republicans in the House, was health care. Democrats argued that Republicans who opposed Obamacare would eliminate the law's regulations governing how insurance companies must treat individuals with preexisting conditions; many polls show those regulations are popular (although public support falls when the public is told about their costs). Republicans appear to have suffered at the polls accordingly, with Republican leaders admitting privately that the issue cost them seats. Biden's plan appears to be to rerun the messaging strategy that proved most successful for Democrats in 2018. 

In doing so, however, Biden will inevitably highlight his own health care plan, which he has billed as an attempt to build on Obamacare. But Biden's plan is better understood as an admission that the law, which Biden helped promote and pass as vice president, has not worked as promised. Biden would spend $750 billion, according to his own campaign estimates, to set up a government-run insurance plan, expanding both the law's coverage subsidies and eligibility for them, in order to accomplish the goals the original law was supposed to accomplish on its own. 

As conservative health policy analyst Chris Jacobs notes in The Wall Street Journal, a little-noticed provision in Biden's plan could end up providing incentives for individuals to move away from employer-sponsored coverage, substantially driving up federal spending on subsidies in the process. Jacobs estimates this effect could raise the cost of Biden's plan to $2.2 trillion, in part by expanding subsidies for people who are already (or would otherwise be) covered by employer-sponsored insurance. Meanwhile, employers would be left providing coverage for older, sicker workers whose premiums would presumably rise; employers might also face higher taxes stemming from Obamacare's employer coverage mandate.  

Employer-sponsored health coverage, an artifact of tax code preferences for workplace benefits, has many downsides, and should not be preserved at all cost. But Biden's plan could upend it in a way that is both expensive to taxpayers and disruptive to current private insurance arrangements with little commensurate benefit. Like so many Democratic plans before it, it's a kludgey technocratic misfire almost certain to result in unintended consequences

Biden's plan to emphasize health care in the wake of Ginsburg's death, however, will likely put pressure on Trump to explicate the details of his own health policy preferences. This may prove difficult because Trump himself has never provided any sign that his health care plan is anything other than disingenuous gobbledygook. 

That was on display last week during a town hall forum with George Stephanopolous of ABC News, during which an attendee asked Trump about his plan for health care and how he would protect individuals with existing health maladies. 

What followed was a contentious exchange in which Trump first promised that a new health care plan was coming that would protect preexisting conditions. Stephanopolous responded by noting that Trump has for over a year promised a new health care plan was coming in the space of just a few weeks, but no such plan has ever materialized; the host also noted that the Trump administration is currently backing a lawsuit to end Obamacare, including its regulations governing the sale and pricing of health coverage to people with preexisting conditions. 

Trump shot back with a garbled word salad that included the following elements: criticism of Obamacare, a claim that he effectively repealed Obamacare by repealing its individual mandate (which is not true), a claim that he ran Obamacare better than Obama (which has some merit), and criticism of Medicare for All (which his rival Joe Biden does not support). Perhaps most surprising was his insistence that, in fact, his health care plan already existed. "I have it already, and it's a much better plan for you, and it's a much better plan," he said, adding shortly after: "You're going to have new health care. And the preexisting condition aspect of it will always be in my plan." 

The notion that Trump's new health care plan exists already was surprising because the administration has released no such plan. Indeed, its existence was news to three Trump administration health officials last week, all of whom denied knowing about any such plan.

Perhaps others in the administration were working on it? That was what White House Press Secretary Kayleigh McEnany suggested when pressed on the issue during a briefing. But McEnany wouldn't provide any details about what was in the plan or who was producing it. Asked for specifics by a CNN reporter, McEnany responded curtly: "I'm not going to give you a readout of what our healthcare plan looks like and who's working on it. If you want to know, come work here at the White House." Less than 50 days before an election, Trump's "much better plan" is apparently such a highly guarded secret that senior administration health officials know nothing about it, and the only way to experience its glory is to quit your job and work directly in the president's inner circle. More plausibly, it simply doesn't exist. 

The contrast between Trump's baldly transparent insincerity and Biden's preference for poorly conceived bureaucratic workarounds will surprise few who have followed recent health care debates. That it persists may be the most normal thing about 2020.  

NEXT: How a Deal to Prevent Court-Packing Can Still Happen

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  1. Presidents shouldn’t have health care plans for the entire country.

    1. This. Health care is a vitally important issue. That does not mean it is a federal issue appropriate for government to “solve”.

      Healthcare has improved a lot in the last century. For the most part, it improved despite, not because of, government interference.

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    2. I said back when the GOP didn’t totally dismantle Obamacare that the game was over because now both parties think government should be solving healthcare. They are expected to “manage” the care of everybody, and I expect they would do so about as well as they have managed covid.

      1. Yup. It’s very similar to the Dems with the Gulf War in 2004. They got that there was some animus against it, but they didn’t actually get why. Obama gets into office and goes “ok, uh, that war? Yeah, I’m gonna take credit for ending that one. But I’m gonna start a few more, because we’re the American Empire and we have responsibilities!”

    3. How dare you!

      Suderman strongly opposed Obamacare.

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    6. The point is, which most of you seem to not get, is that in the absence of a plan, Medicare, Medicaid, and Obamacare stay in place. You have to pass legislation to change something, even if that’s getting out of a field you got in to. So not having a plan is NOT libertarian, it’s a surrender to the status quo.

  2. There’s a clear political logic to Biden’s move:

    That’s a group of words and syllables I thought I’d never see arranged in seriousness.

    1. There’s a clear logic to Biden’s move:

      ^ Sentence with a near-0% chance of being true.

      There’s a clear political logic to Biden’s move:

      ^ Sentence with a non-0% chance of being true.

  3. So now reason is shilling for another government program boondoggle. Days of yore when you used to be against all this. Just call yourselves democrats and get over it.

    1. They’d all feel so much better about themselves.
      No more long, awkward explanations at cocktail parties about how they’re not like those other libertarians,
      and how for them it’s mostly just about bum sex and drugs and legal prostitution and other things that appeal to urban progressives,
      and they’re totally cool on abortion, and willing to compromise on guns and schools.

      1. No more long, awkward explanations at cocktail parties about how they’re not like those other libertarians,

        The real problem is 90+% of articles on this site would just openly start with “I was reading over at Vox/WaPo/NYT…” and the perfunctory “to be sures” would just become outright acknowledgements that some people do legal things that mean they should have their rights stripped from them.

    2. So that’s what they meant by “bad ideas?”

      Thanks for clarifying.

      1. C’mon, sarcasmic, you know how it goes. Throwing shade on Trump’s healthcare non-plan automatically means that you must support Medicare For All.

        1. If you oppose “no plan” then you support “a plan”.
          It’s not complicated.

          1. Opposing? No, they’re pointing out that it’s disingenuous to say you have a plan when you don’t. You can’t figure that out because you get sand in your twat whenever someone says something unflattering about Dear Leader.

            1. No, they’re pointing out that it’s disingenuous to say you have a plan when you don’t.

              1. Forthrightness.
              1.2. Property rights.
              2.3. Non-agression.

              Good God, the only thing better than you chumps’ tears is that in 20, 30, or 40 yrs., when you’re the absolute laughingstock of history, those tears will taste even better.

              1. Is that your plan, or Trump’s plan?

                1. At this point what difference does it make?

        2. “Trump’s healthcare non-plan ”

          When did “take care of yourself” become anathema to Libertarians?

          1. Is that Trump’s plan? Or is that what you would like it to be?
            We are talking about the Trump who supports and defends Medicare, and supports and defends socialized medicine for vets.

            1. Socialized medicine for vets???

              That is a bizarre way to describe a generous benefits package provides as part of the employment contract.

              1. He’s not capable of understanding that.

          2. It hasn’t. That suderman posits it as a problem tells you what he really is.

        3. You two make a cute couple.

  4. Biden would spend $750 billion

    That’ll cover the first two weeks…

    1. Enough to set up the rationing and make sure everybody dies before they get any care.

  5. Perhaps most surprising was his insistence that, in fact, his health care plan already existed. “I have it already, and it’s a much better plan for you, and it’s a much better plan,” he said, adding shortly after: “You’re going to have new health care. And the preexisting condition aspect of it will always be in my plan.”

    This is why I like Trump’s plan best. It probably doesn’t exist. There’s nothing more libertarian than voting for a plan that doesn’t exist.

    1. So wait, he has a plan but he’s not going to show anyone? Is this one of those we have to vote for the bill to see what’s in the bill type things?

      1. More likely, and hopefully, it’s one of those quietly backing out of the room so no one notices kinds of things.
        Less Daddy Gov is good

    2. The best thing about a government plan that doesn’t exist is that it is equally applicable to everyone.

      Libertarian moment!!!!!!!

  6. “The common threads between the critics who served in the Trump Administration are (1) a willingness to serve as advisors to Donald Trump and (2) a realization that Trump is bad for the country after spending time in proximity to the president.

    The sheer number of former Administration officials who raise red flags about the president leaves only two possibilities:

    1) Donald Trump is lousy at picking people who are loyal and tends to hire people who are unprincipled enough to seek revenge by making up outlandish stories.
    2) The testimonials are true and Mr. Trump’s behavior is so egregious and dangerous that he represents a national security threat.

    The evidence points to the second possibility.”

    https://www.stridentconservative.com/trumps-toughest-demographic-former-administration-officials/

    Trading DC swamp rats for NYC sewer rats has gotten us only even more septic rats.

    1. The evidence points to the second possibility

      Three unprecedented peace treaties, zero wars, massive deregulation, two decent supreme court picks, rapport with North Korea and a new North American trade agreement that’s vastly superior to NAFTA is so egregious and dangerous that he represents a national security threat?

      Whoever wrote that deserves a kick in the head.

    2. So let me get this straight. Trump is secretly insane when he’s not in public, and the people leveling this accusation are the sane ones, even as they’re burning down their own cities when they’re not screaming at the sky or theorizing about mail truck thieving conspiracies. Makes perfect sense.

      1. when they’re not screaming at the sky or theorizing about mail truck thieving conspiracies

        Don’t forget the Russians and the Koch Brothers!

      2. The fucking idiot you’re responding to has a case of TDS which we can all hope is fatal.
        Painfully and drug out besides.

  7. >>many polls show those regulations are popular (although public support falls when the public is told about their costs).

    people believe the lie until the truth lights.

  8. ” Biden’s plan could end up providing incentives for individuals to move away from employer-sponsored coverage, substantially driving up federal spending on subsidies in the process. Jacobs estimates this effect could raise the cost of Biden’s plan to $2.2 trillion, in part by expanding subsidies for people who are already (or would otherwise be) covered by employer-sponsored insurance. Meanwhile, employers would be left providing coverage for older, sicker workers whose premiums would presumably rise”

    Dude, think about what you’re saying. Employers would be left paying fewer premiums. They’re going to like this.

    1. Employers would be left paying fewer premiums. They’re going to like this.

      Restatement: employers are going to like getting fewer tax breaks.

      The only thing employers hate about Obamacare is the ridiculous amount of (and in some cases impossible to complete correctly) paperwork. You are an idiot who clearly knows nothing about the business of health care benefits. You stank up an earlier thread being wrong about pre-existing conditions. We know you are a fool, but, by all means, keep proving us right.

      1. “…We know you are a fool,..”

        Entirely too generous and fools are insulted.

  9. This may prove difficult because Trump himself has never provided any sign that his health care plan is anything other than disingenuous gobbledygook.

    Kind of like a certain someone’s Reason column…

    Anyway, from a libertarian perspective an imaginary government healthcare plan is the best government healthcare plan possible.

    1. Exactly. We’re not just getting after politicians because they “don’t have a plan” to nationalize an entire sector of the economy.

      1. You have to admit it is funny that suderman thinks this is a credible argument.

  10. Well I am glad to see that on her campaign page JoJo has at least name-dropped the Singapore model for health care.

    https://www.commonwealthfund.org/international-health-policy-center/countries/singapore

    There is still an awful lot of central government control in the Singapore model, but adopting something like their MediSave plan here would be a big improvement, along with decoupling employment from health insurance. Basically, at least as far as I can see, MediSave is a program in which everyone gets their own HSA funded through mandatory payroll deductions, plus some government subsidies. That way everyone is in charge of their own fund to cover deductibles and copays for themselves and their families, and with decoupling of health insurance from employment, individuals could shop around for health insurance like they shop now for car insurance or cell phone plans. It’s not Libertopia but it is a step in the right direction, and it is actually a currently existing functioning model for the h8rs out there who continually scream BUT BUT LIBERTARIAN IDEAS DON’T WORK IN THE REAL WORLD.

    1. govt mandates and subsidies = Libertarian?

      1. No, not particularly. But the Singapore model IMO is a step in the right direction compared to where we are at. We ought to be striving for a goal of individual control over one’s health care choices. Singapore is a better way to accomplish that compared to what we currently have.

        1. “…But the Singapore model IMO is a step in the right direction…”

          Your mom may care; that’s about it.

    2. If you’re going to run as a libertarian run on Libertopia.

  11. You think abolishing preexisting conditions by the Supreme Court, along with the rest of the ACA, on the one hand, and Medicare for All courtesy of the Democrats, on the other, is the dynamic here–with the Republicans caught in the middle?

    Sounds like wishful thinking.

    For one thing, the Democrats, with minority Republican support, can bring back the preexisting conditions provision by itself–even after the Supreme Court abolishes the ACA on the narrow grounds that because Congress has set the penaltax at zero, the whole house of cards falls apart.

    It’s the same thing with DACA. If the Supreme Court had already abolished DACA, that doesn’t mean the Dreamers would have all been deported by now. It means that Congress would have been forced to save them rather than just leaving them to twist in limbo. If the Supreme Court ruled against DACA tomorrow morning, Nancy Pelosi would have the bill to save them passed by tomorrow afternoon–and President Trump would be pressuring the Republicans in the Senate to sign his bill to save them, too.

    The main point here is that the Republicans don’t need to take a defensive stance against whatever the court does until after the court does it–and probably won’t take action unless the court makes a ruling–regardless of whether the Democrats want to make an issue of it or not.

    Progressives love to imagine they’re setting the agenda even when they aren’t. When all the progressives have is a hammer, I guess every bit of opposition appears to be reactionary to them. No doubt, their evil plans for the Green New Deal and Medicare for All are awful, but the Republicans are happy with the status quo at least until the Supreme Court upsets the apple cart.

    1. and President Trump would be pressuring the Republicans in the Senate to sign his bill to save them, too.

      That would depend on what Sean Hannity and Fox & Friends told him to do.

      1. It’s funnier when Tony says it.
        He’s much, much, much more likeable than you.
        And Tony isn’t especially likeable.

        1. Mean Grrl Score: 7/10

          1. Baby Jeffy Plagiarized Shtick Equivalence Ranking: 2.86

            Ouch. That really didn’t impress the Russian judge, Yakov Shmirnov, who said, “In Russia, all girls are mean girls.”

          2. Stupid fuck score: 10/10

            1. At least he doesn’t shitpost ultra long rambling screeds like the late Mike Hihn.

    2. Progressives love to imagine they’re setting the agenda even when they aren’t.

      Their more recent problem is that this is true even when they’re in the act of deliberately upsetting their own agenda.

  12. One thing should be absolutely clear: Joe Biden doesn’t have a plan either. Barack Obama didn’t have a plan. Sure, they had numbers on papers, but they knew they were going to have to lie about them and manipulate them to make them work. Moreover, even if they got them to work, they advocated policies like unfettered immigration and (now) lockdowns and mask mandates that absolutely blow those numbers to hell. So, when Biden says he has a plan, Trump’s transparent “disingenuousness” is the more honest answer.

  13. How are libertarian candidates not crushing it every time? You have liberty versus authoritarianism. I guess it’s true people want to be told what to do.

    1. The national LP is not very bright when it comes to counterinsurgency, infiltration and 5th columns–not to mention Jobba the Whacks. Jeremy, “our” candidate for VP, is a communist anarchist, which hands the Gee-Oh-Pee AND the commie Dems the perfect baseball bat with which to beat Jo’s campaign into a blob. State and local LPs are way better at using spoiler votes to ditch bad laws.

  14. “I’m not going to give you a readout of what our healthcare plan looks like and who’s working on it.”

    It’s going to have to be passed as law for you to see what’s in it!

  15. The Republican answer to healthcare is to preserve the medical cartel, but thin the herd by selling hunting licenses to shoot birth control doctors. The Democrat plan, as always, is to preserve the regulated cartel and force you at gunpoint to pay for government quackery and government schools–and have government school shootouts thin the herd. The initiation of deadly force is fundamental to both entrenched parties.

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  17. Health care policy should be left to the states.

    1. Or the people; why involve any government?

      1. It’s too late for that. Unless you want doctors, nurses, drugs, medical devices, etc, to be completely unregulated and have no licenses or approval.

        While I actually wouldn’t mind that, I don’t think most people would.

        1. I would. Medicine is a group effort. The surgeon needs to rely on many other people, lots of them he or she may not know or hardly know. The nurses, OR techs, radiology, pharmacy, administration, anesthesia, hospitalists, internal medicine docs, ED docs, equipment makers, on and on. All of them contribute in vital ways to the care of the patient. There is no way for one individual to do that.

          Most of what happens is internal to the industry, not the government. The government mostly signs off because they recognize medical boards and non profits such as the Joint Commission.

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  19. The problem is there is a Federal healthcare plan. I doubt we will or even can go back. When is the last time you saw the Federal government repeal a program? Also costs skyrocketed with the plan, many of those that could afford to purchase private insurance can no longer afford to do that. I doubt cost would come down with a repeal. Government always invests most heavily in government growth!

    1. I agree that it is unlikely that we will see an end to government provided healthcare. If Republican do succeed in over turning the ACA, I think you will see support build for Medicare for All (M4A). Healthcare is a recurring issue during elections and it will continue to be the case. The ACA is based on conservative principles and is the best answer for a market based health care system. Eliminate it and M4A is left as the alternative. This is why I think it unlikely SCOTUS will overturn the whole ACA.

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  22. I agree that it is unlikely that we will see an end to government provided healthcare. If Republican do succeed in over turning the ACA, I think you will see support build for Medicare for All (M4A).
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