health care

Trump Still Doesn't Have a Health Care Plan. He Does Have a $6.6 Billion Medicare Bribe for Seniors.

After years of promises, Trump unveils a meaningless executive order on preexisting conditions and a prescription drug gift card for seniors.

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At long last, President Donald Trump has announced his health care plan. The problem is, it's not a health care plan. It's an empty promise attached to a federally funded bribe. 

The saga of how we got here is a long and annoying one, filled with policy arcana that is both incredibly important and almost entirely irrelevant since it is so often discarded in favor of political imperatives. Trump has rendered the entire health care debate into a glum farce. 

From practically the moment he began running for president, Trump promised to repeal and replace Obamacare, the health care law signed by his predecessor, Barack Obama. Republicans in Congress spent most of the first year of Trump's presidency working on various repeal and replace plans, but they never coalesced around a single proposal, and the final attempts were essentially legislative shells structured so that the details could be filled in later. Even as the GOP attempted to pass actual replacement legislation, it could not, in the end, describe what that replacement would be. No major health care bill was ever signed into law.

Still, Trump persisted in promising that a new health care plan was forthcoming, saying on multiple occasions over the last several months that it was imminent—just two or three weeks away. 

At no point did Trump provide any substantive details about what would be in his new plan; at most, he would promise that it would offer some form of protection to people with preexisting health conditions, without explaining precisely how. That promise was complicated by the fact that Trump was backing a legally dubious lawsuit to overturn Obamacare, including its rules governing how insurers must treat people with preexisting conditions. 

There were legitimate arguments to be made that those rules raised premium prices for buyers of individual market health insurance, and even that they provided some incentives for insurance companies to provide worse coverage to the chronically ill. But Trump wasn't making those arguments. Instead, when asked about Obamacare's preexisting conditions rules, he would say, with characteristically jumbled syntax, something that sounded roughly like a promise to keep those rules in place. Trump was not teasing an alternative mechanism, or offering a critique of Obamacare; he was trying to have it both ways, pushing to strike down Obamacare in the courts while insisting that he would preserve its core insurance regulations.  

Last Thursday, with the election barely more than a month away, Trump revealed his vision for health care, including his plan for protecting preexisting conditions. It is exactly as substantive as his earlier promises to protect preexisting conditions, which is to say that it is almost completely without substance. To protect people with preexisting conditions, Trump said he would sign an executive order declaring that it is the policy of the United States to protect people with preexisting conditions. 

That is not a policy mechanism. It is not legislative edict. It is a statement of intent, backed up by nothing. It is equivalent to declaring that it is the policy of the United States that henceforth all watermelons shall be seedless. That might be desirable, but it is not going to happen without a mechanism in place to make it happen. It is not a plan, because Trump—still—does not actually have one. 

Instead, he has a gimmick. At the same speech last week, Trump said he would send 33 million seniors $200 prescription drug gift cards. Think of it as the political equivalent of a retailer offering a holiday promotion, except the holiday in question here is the election. That is Trump's preelection pitch to seniors: Here's $200. 

If enacted, Trump's gift card program would cost about $6.6 billion. In theory, that money would come from savings from a prescription drug program referred to as "most-favored-nation" pricing, which would guarantee the United States doesn't pay more for drugs than other countries. But that program hasn't gone into effect yet, and the administration has been tellingly quiet about the specifics, with one White House official telling reporters: "Unfortunately, the details of the offsetting requirements [of the Medicare drug pricing program] are still yet to come. Expect more details out of the White House in the near future." As always with Trump and health care, the specifics will arrive later. 

Nor is it clear whether the program could even legally operate through Medicare's demonstrations program. That program was intended to allow small-scale experiments with payment models, which, if successful, could then be scaled up to provide savings to the program as a whole. Trump's plan to give $200 gift cards to 33 million seniors looks less like a small-scale experiment designed to find a way to save Medicare money and more like a program of taxpayer-funded bribery. 

Which, needless to say, is also not a health care plan in any meaningful sense. Because Trump never really has a plan. He has gimmicks and delaying tactics. That's it.

Occasionally, when I complain that neither Trump nor most of his fellow Republicans have health care plans to speak of, libertarian-minded readers respond that politicians shouldn't have health care plans, because the federal government shouldn't be in the business of managing American health care at all. 

I agree that the federal role in health care should be significantly diminished. The problem with this is that the federal government is already in the business of managing American health care. One could plausibly argue that spending money on health care is the primary thing the federal government does. 

In 2019, the federal government spent about $630 billion on Medicare alone, an amount projected to rise to about $1.3 trillion in 2029. One of Medicare's key trust funds is set to become insolvent in 2026, yet Trump has promised not to touch the program. Major health care programs—particularly Medicare and Medicaid—are among the largest federal budget items and biggest drivers of long-term federal debt. About one-sixth of the total economy is devoted to health care, and by the end of the decade it will be closer to one-fifth; about half of that spending comes from the federal government. Meanwhile, health insurance post-Obamacare has remained unaffordable for many middle-class families; longstanding tax incentives for employer-subsidized health insurance create logistical headaches and problematic incentives for insurers. Pricing for health care services is opaque and maddening.

No plan means no effort to address any of those issues. It means leaving the status quo, with all its problems, in place. Which, on the evidence, appears to be Trump's actual plan. 

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  1. health insurance post-Obamacare has remained become even more unaffordable for many middle-class families

    thanks to Obamacare

    1. Actually I recall the rate of premium rises slowing for some years once the ACA passed.

      1. Yes, but the rise in deductibles made up for it.

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          1. But do you have good health insurance?

      2. Not where I live, at least not in the individual marketplace.
        ACA gave it to me too good and hard to be gaslighted now.

      3. I’m self employed and under 40. I don’t drink and I don’t smoke. I work out three times a week and I see a nutritionist once a month on my own dime. It would currently cost me $600 a month to get on my wife’s plan from her employer. I understand this is anecdotal, but prior to obamacare I could find dirt cheap catastrophic insurance policies with high deductibles. Now I pay a fine once a year because there is no way I’m paying $7200 bucks a year.

        I’ve never lived in a country with ACTUAL free market healthcare, but it wasn’t as bad prior to obamacare. It’s almost like government bureaucracy just makes everything less efficient and more expensive. Hooray for coercion in the name of pretending to help poor people!

        1. Free market health care?
          Like when you have an emergency, you want to shop around while riding in the ambulance and give orders to the driver on which hospital you go to. Then when you go for surgery, you need to pick and choose the surgeon, the hospital, the nurses, the anesthesiologist, the surgical assistance etc.

          Or are you talking insurance?

      4. Actually it went from 100 to 400 for one person here over night.

      5. It actually forced me off my preferred policy – since that had become illegal – and back into Tricare.

    2. but FIRE couples making 300 or 400K can retire at 40 and buy subsidized insurance on the exchange, which doesn’t really seem like what it was for…

  2. $6.6 billion? Why do I feel we’re getting off cheap?

    1. That is why Trump must go.

      He has the audacity to suggest cheaper government programs and try to cut government.

      1. Or at least he talks about cheaper government programs and trying to cut government.

        1. Unlike Lefty Propaganda, the President doesnt control the national Purse. Congress does.

          1. Or TDS sufferers.
            Any day now, Trump will propose the perfect health care plan. Cheaper, better, faster and will have Trump’s name on it.
            You just wait! It will be wonderful.

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  3. “Trump Still Doesn’t Have a Health Care Plan”

    JFC this canard again…

    1. >Libertarians still don’t have a plan for the economy!

    2. Where is his health care plan? Can you link to a white paper or outline?

      1. Where is Biden’s health care plan? Can you link to a white paper or outline? Since I’m sure you’ve done extensive research on the subject you should be able to provide a cite on demand, no?

    1. What a strange story. Disturbing if true.

    2. When you’re famous they let you grab them by the buttocks then they sue you.

    3. Lol. Are any of these rightwing assholes not perverts?

      1. Lol. When did you stop beating your husband Tony?

      2. That’s strange coming from Tony.

      3. Now you’re kink-shaming Tony? You’re gonna get cancelled.

  4. Trump Still Doesn’t Have a Health Care Plan.

    According to Suderman, Trump HAS to have a health care plan.

    The fact that Trump is fighting ObamaCare and picking small gestures ($6.6billion of $1 trillion Medicare costs per year) shows how Lefty Suderman is.

    unreason staff are going to needs lots of psych meds when Trump is reelected.

    1. To me, the most libertarian position is to not have a healthcare plan.

      1. This is true if government wasn’t involved in healthcare already. The proper plan would be to get government out of the business entirely. That’s sort of the point of the article, but it does come across as very TDS-laden. It’s hard to blame Trump specifically for not eliminating Obamacare, but certainly Republicans in general failed to do so.

        1. Yep, McCain and other rinos got in the way.

    2. These headlines are pretty typical of Lefty Propagandists who frame every story about health care where a government plan is needed.

      Nevermind that Americans can pay cash for minor medical stuff and have catastrophic health insurance for major medical stuff (if they want it). Cut $2 trillion in taxes for Social Security and medicare would give Americans more money to spend themselves.

      1. Right. The options aren’t 1 plan vs. 0 plans, it’s 330 million plans vs. 1 plan.

  5. government spending money is only a bribe when trump does it somehow

  6. “No major health care bill was ever signed into law.”

    I fail to see why this is a problem or, for that matter, why a purportedly libertarian publication would be in favor of massive federal legislation controlling and/or manipulating access to healthcare services.

    “Pricing for health care services is opaque and maddening.”

    And another major federal overhaul of the insurance market would somehow simplify the situation?

    1. Theoretically, an outright repeal of Obamacare would be legislative action on healthcare that libertarians would support.

      Reason simultaneously holds the position that Trump should’ve just ignored Congress and reformed healthcare on his own, and also that him doing so would be a tyrannical overreach of executive power.

      1. Agreed.

        The signaling here is very inconsistent.

        1. Very consistent: Orange man bad!

  7. He Does Have a $6.6 Billion Medicare Bribe for Seniors.

    Sounds like a plan to me.

  8. should be able to contract with my doctor to pay him how I want and what he accepts.

    1. Indeed.

      The only universe in which this approach does not make sense is one in which healthcare services are presumed to be a positive right — which is another way of saying that one is entitled to benefit from the labor of others without compensating them.

      1. If our rights have to come free of cost let me know when I can expect my shipment of government financed machine guns.

    2. Sure but your doctor doesn’t care. He or she works for a large group practice, big hospital practice, or corporation. They just do not want the headache. It is not what they signed up for.

      Overall what we have now is not terrible. People get taken care of somehow. The old advice still holds. Someone once said to a newbie starting out “don’t worry. Just take care of the patient in front of you. The rest is insignificant.”

      1. There are plenty of private practice doctors who would disagree with you. The consolidation into large groups and the growth of employee model is in response to the current administrative load imposed by government interference. Remove that, open up the market, and competent solo doctors would thrive, as in the time before Medicare (1965).

        1. There are many advantages to larger group practices and employment. You have no billing headaches to deal with. You can get a regular schedule with time off. You get benefits like insurance including malpractice insurance and 401k. You do not need to arrange for call.

          There are downsides no doubt.

          I know this. It works better for almost everyone. There are a few who prefer something else. Bigger or smaller private groups, often in surgery still basically function this way. The only thing you give up is you have to basically pay the suites and other people to do all that. You produce the only product they sell. Most are willing to do that to have a better life.

          It is not all about the government although certainly that impacts. Yet most only signed up to diagnose and treat disease. It is what you want to do. Trying to operate a business gets in the way of that.

    3. So, do you pre-negotiate what happens if you get cancer? Or negotiate after you get diagnosed for cancer?
      How’s that ambulance ride looking? As you fade in and out of consciousness, do you want to negotiate which hospital they take you to.

      How about you get an insurance, that takes into account the group risk and spreads the risk accordingly? Let the insurance company pre-negotiate/setup deals etc. with all the hospitals, emergancy rooms, ambulance services, doctors, surgeons, nurses, PA, X-ray techs, MRI, ….. Who the f*ck has time for that?

      The only real issue is how do you setup a group to get this insurance? Currently its by company which sucks for the worker and sucks for the company. Small companies have to struggle with the bill (and may not be able to even hire some people because of medical insurance risk) and workers cannot leave the company for insurance stability reasons.
      Enter Obamacare. Slightly broken, but only because the insurance companies got their fingers in the initial legislation.
      Biden’s plan is to tweak Obamacare (Even Obama knew it had flaws).
      Dump the VA medical, Medicare and Medicaid and make it all one voucher program.

  9. Trump Still Doesn’t Have a Health Care Plan

    OH NO!

  10. Sorry the Santa Claus method won out over balanced budgets. That ship sailed long ago and now nobody except a third party cares one bit. Give it up, let it crater (when some democrat takes office haha) and fix it later.

    1. “In 2019, the federal government spent about $630 billion on Medicare alone, an amount projected to rise to about $1.3 trillion in 2029”
      COVID might bend that curve

  11. “He Does Have a $6.6 Billion Medicare Bribe for Seniors.”

    Interestingly enough, $6.6 billion is the amount Reason.com’s benefactor Charles Koch has lost this year because of Drumpf’s high-tariff / low-immigration policies.

    #HowLongMustCharlesKochSuffer?

    1. The more you learn! That is an odd coincidence, almost too good to be a coincidence at all. Hmmm….

  12. I mean, I hate Trump but let’s be fair, the REPUBLICANS had 7 years of non-stop whining where they could’ve presented *anything* to improve healthcare in this country and they did jack.

    It’s much easier once you see they have no real political agenda besides passing tax cuts for the rich. That and just opposing anything a Democrat ever says or does.

    1. REPUBLICANS had 7 years… where they could’ve presented *anything* to improve healthcare in this country and they did jack… no real political agenda besides passing tax cuts

      Um, I know it’s hard to tell with writers like Suderman, but this is ostensibly a libertarian website.

      Governments doing jack and cutting taxes is the whole point

      1. Not according to Tony.

        1. The status quo, or perhaps a status quo left to decay, is not anything like libertopia, is it?

          And you’re not going to stop driving on my roads no matter how much you supposedly hate government doing stuff, are you? Thief.

          1. Really? Muh roads?

            1. An argument doesn’t go away just because you mock it.

          2. They’re my roads too now. Since you’ve forced me to buy into them.

            Right now my neighborhood’s greatest worry is that the county is going to pave our roads – which we don’t need them to do – and then stick us with a bill for it despite not wanting it.

      2. What’s wrong with tax cuts for the rich? Gotta start somewhere.

        1. Because they are the only ones that can afford to pay taxes?
          Why not start at the bottom?

    2. Yeah I hate paying that mandate penaltax.

    3. IIRC Trump said he’d sign repeal if Congress sent it to him.

      1. Trump is allowed to propose laws to congress.
        Being president is not all executive orders.

    4. The Democrats had 8 years of non-stop whining where all they managed to accomplish was screwing up health insurance.

      So no we pay a lot of money to ensure some more people have health insurance that didn’t before (while ignoring those that did that no longer do) and those people still don’t have ‘access to healthcare’ – because no one takes their insurance.

  13. “Trump has rendered the entire health care debate into a glum farce. ”
    The decent of the debate into a glum farce predates Trump, but orange man bad and TDS for every situation. What will people do once they can’t blame their favorite boogeyman for every single perceived problem they encounter?

  14. Biden has a health care plan too. It’s..
    around here somewhere..with the thing……nurse?!?

  15. “Trump Still Doesn’t Have a Health Care Plan”

    Sounds good to me.

  16. So, Suderman doesn’t like Trump?!

    Wow. Who knew?

  17. To be fair, Trump still doesn’t have a plan to build a big beautiful wall from sea to shining sea and have Mexico pay for it or a plan to lock up Hillary Clinton or a plan to retire the national debt either. It’s almost like he’s a bullshitter just like every other politician who tells you all the wonderful things they’re going to do and then manage to accomplish none of it when they get elected. Do you remember Obama shutting down Gitmo, ending our pointless wars, healing the planet, promoting racial healing, or letting you keep your doctor?

    1. shutting Gitmo, ending wars, healing the planet, racial healing, keeping your doctor”

      Yes, but you don’t understand. The Lightbringer really did all those things but the Republicans wrecked it all somehow.

      1. He was going to heal the planet but we didn’t deserve it.

    2. Trump did finally see his tax returns released.

      1. Yes, and NYT reported he paid no tax, but guess what? He paid millions in AMT! Not reported! Un-ffing-believable!

  18. What, BSed by Trump? BSed on health care by Republicans? Couldn’t be! They’ve only done that since 2008. What a laugh…an executive order to protect preexisting conditions. But I’m sure the phony libertarians here will love it…they can’t get enough of this man’s con.

    Here’s a thought for Libertarians…let government just take a few more steps to handle health care and FINALLY take it away from businesses, which they’d surely love anyway. Take those administration tasks off of businesses. Free businesses!

    1. Typical Buttplug;

      “phony libertarians here”

      but then he goes and says this,

      “Here’s a thought for Libertarians…let government just take a few more steps to handle health care and FINALLY take it away from businesses (to government)”

      Lol, he’s so shit at coherent shilling.

      1. Hey, mommy! Glad you’re following me and can’t get enough…I like the laughs!

  19. Wait, isn’t it a good thing that he’s keeping the government out of it?

    If we wanted “plans”, we would have voted for Warren.

  20. “last week, Trump said he would send 33 million seniors $200 prescription drug gift cards.”

    But giving millions of the unemployed $600 a week wasn’t bribery at all, no sir re bob.

  21. What a stupid idea.

    Then again you have to consider the source. I think he should also go with free TV with unlimited episodes of Matlock and The Golden Girls.

    His health care plan is to hand out trinkets to seniors? Gift cards like their nephew sends them on Christmas? The Golden Corral again. She has a drawer full of those.

    They are old not idiots.

    He just keeps handing out cash in a pathetic attempt to buy votes. As if it were other people’s money.

    1. At least Bloomberg is buying votes in Florida with his own money.

  22. Old-age healthcare should be pretty cheap once we complete the Trump-libertarian covid plan of turning all the old people into economic stimulus for mortuaries. If you wanted to go proper dystopian you’d advocate turning them into food, of course. Feckless assholes.

    1. I’ll take care of my grandma, you take care of yours.

    2. I think you’ve confused Trump for DeBlasio and Whitmer.

      You know, the two politicians with the biggest Covid death counts related directly to their *requiring* nursing homes to take in Covid positive patients – including those that were nowhere close to being seniors but were just violent teens and young adults. Placed to live with the vulnerable elderly.

      That’s your modern Democratic Party bud.

  23. How and why would he have a healthcare plan? We must first get rid of the ACA. You know, the mountain of rat poop based on models that would never work here and that was put it place through deceptive means.

    We have Medicare/Medicaid and private health insurance. Creating a national “healthcare plan” without getting rid of private insurance companies does nothing but magnify costs and impact on working people. Like the ACA did/does.

    Trump HAS been and IS working to get rid of the ACA. Like he said he would. After that it’s back to the drawing board. Just wait until your beloved masters are forced to deal with getting rid of private insurance companies to create actual national healthcare coverage. They’re enslaved to them. The profits are obscene and the medical care costs are outrageous because of our insurance companies. It won’t go quietly. There isn’t enough popcorn for that event.

    Defending Trump sucks, but you know what? He’s better than everything the Democrats offer up and better than the confused, impotent ghost running for the LP. Maybe focus on those topics instead of crying “but Trump!” when you refuse to even consider reality.

    1. And four years later how has Trump delivered on that? Yet you are going to continue to support him.

      Pre existing conditions. We already had that. $200 gift cards. Great idea to deal with Medicare.

      Far as I am concerned keep government out of it. That will not be on the table between the two government parties.

  24. Didn’t read the article, because this is Reason; but I just want to say that 6.6 billion dollars will buy my vote.
    (or are we supposed to share it?)

  25. You cannot have a serious medical plan without changing the system from being controlled by Big Pharma and the drug cartels to that of a health first based system. That is where prevention and wellness come first, not simply disease management with the endless use of drugs for everything. Our entire health care system is bass-akwards. That is why it is super expensive and full of failure after failure.

    1. Who decides what health is first? AOC?

  26. It’s like the old school mafioso who rips off the neighborhood and buys everyone a turkey on Thanksgiving

  27. Trump Still Doesn’t Have a Health Care Plan. He Does Have a $6.6 Billion Medicare Bribe for Seniors.

    We’re libertarians – why would we think the first part is a negative? We should be *glad* he doesn’t have a plan. All we should care about is can we get him out of the way of the rest of us implementing *our* plans.

  28. Wanting to abolish the ACA is a plan, with the ultimate goal to get government engineers out of healthcare. Let the private sector sell low cost catastrophic plans; currently such plans are outlawed. I used to have one and it was excellent.

    1. Was it still low cost once you had a catastrophic illness?

  29. Very small compared to the Democratic bribes:
    Obama phones
    Free college tuition
    Loan forgiveness
    Racial reparations
    Free health care (though it won’t be free)
    The ‘New” new green deal

    Buying votes has been going on for a long time in this country, why blame Trump for getting on the bandwagon now? You gotta fight fire with fire. And, no wonder this country is broke! The Politicians just love to give away OUR MONEY to get reelected.

  30. And four years later how has Trump delivered on that? Yet you are going to continue to support him.

    classroom of elite season 2

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