Posted on 02/08/2016 7:27:14 AM PST by SeekAndFind
Donald Trump doesn't know what he thinks about health care. He has been a periodic advocate of a United Kingdom–style monopoly system and a periodic critic of such monopolies. He says that we should repeal the so-called Affordable Care Act and replace it with . . . something. Something "terrific."
Well.
When asked by New Hampshire debate moderator Mary Katharine Ham whether his flirtations with single-payer leave him closer to Vermont socialist Bernie Sanders than to mainstream Republicans, Trump gave a hilariously incoherent answer based in one part on banalities and one part on lies -- which is the Trump magic formula. He said that he was the only candidate on stage free to explore all the policy options because he is self-funded and therefore not beholden to special interests. Trump is in fact mainly funded by donors, like the other candidates, but he persists in this lie, brazenly. He also claimed that the insurance companies are "getting rich on Obamacare," which would be news to United, Cigna, Aetna, and others who have taken a bath on their ACA offerings. (They might have thought they were going to get rich -- it's nice to have a federal law mandating the purchase of your product -- but, having gone to bed with the devil, they are waking up with a burning sensation.) Trump also promises a system that would not leave Americans "dying on the street."
Trump likes to talk about "deals," and to tout his purported expertise as a dealmaker. To the extent that he has communicated anything that deserves to be called an idea on the issue of health care, it is in joining in with Barack Obama, Bernie Sanders, Hillary Rodham Clinton, et al., in calling for government negotiation with pharmaceutical companies over prescription-drug prices. Trump promises to apply the business acumen he has brought to the casino racket and his reality-television enterprise to negotiate better deals on pharmaceuticals.
It is a superficially appealing position: About two-thirds of Republicans tell pollsters they believe the government should engage in such negotiations. As things stand, the Department of Health and Human Services is prohibited from engaging in direct price negotiations with pharmaceutical companies, a rule that was adopted in the creation of Medicare Part D, the competitive prescription-drug benefit program. There were three reasons for that: One, it was a sop to the pharmaceutical companies; two, Congress and the George W. Bush administration had quite reasonable concerns that transferring the price-negotiating function from private insurers to the Centers for Medicare and Medicaid Services would create something like a price-fixing monopsony; three, the experience of Medicaid suggests that such negotiations might backfire, with pharmaceutical companies raising their prices in the private market to create the illusion of steeper discounts for government buyers.
Barack Obama had campaigned on undertaking such negotiations, but, in a rare concession to reality, he quietly dropped from the ACA a provision that permitted them. The idea that a team from the Centers for Medicare and Medicaid Services is going to sit around a table with the top brass from Merck and Purdue and hammer out standing deals covering the thousands of permutations of pharmaceuticals American medical patients receive is impractical, to say the least. The Obama administration and Mrs. Clinton have since changed their approach, suggesting that the government become involved in direct negotiations over the prices of a small number of very expensive drugs, such as biologics, especially those that do not have very many competitors.
The belief that a single federal health soviet is going to come to a better settlement than a large number of insurance companies negotiating a large number of different deals to serve a large number of different interests is a classic example of monopolistic progressive thinking, something for which Trump, who currently styles himself a conservative of some sort, has a weakness. In reality, one of the reasons private-sector negotiation has failed to produce large savings is that the private insurance companies face prohibitions of their own, thanks to federal regulation.
There are six classes of care that are "protected" by federal regulation, meaning that private insurance plans doing business with Medicare are obliged by law to cover "all or substantially all" prescription drugs related to them. Which is to say, the law ensures that insurance companies are in a weak negotiating position, because they cannot walk away from the transaction -- in the end, they are required by federal law to buy the drugs. There's a little poetic justice in that: Under the ACA, insurance premiums are going up, because consumers are required by law to carry certain insurance; the insurance companies are in the same position (an unwieldy federal mandate) vis-Ã -vis certain pharmaceuticals.
The Congressional Budget Office studied the question a few years back and concluded that direct negotiations probably would not have much effect on overall prices. In a report for the National Bureau of Economic Research, professors Mark Duggan and Fiona M. Scott Morton found that a larger Medicaid footprint in the market for particular drugs was associated with higher prices, not lower prices: A 10 percent increase in Medicaid's share of the buyers' market for a prescription was associated with a 7 to 10 percent increase in the average price of that prescription.
Trump goes astray in the same way that Obama, Sanders, and Clinton do: in the assumption that what ails American health care is profit. What actually ails American health care is demographics, with an aging society undermining the finances of Medicare and the Social Security disability program; defective markets in which state-by-state insurance licensing prevents the emergence of a national market, and hence national competition, for insurance services; preexisting regulatory burdens that all but ensure high prices for health-care consumers; special-interest concessions written into every program from Medicaid to Obamacare, paid out as the price of industry support for various federal interventions. If Trump's confused answer about "lines around the states" was a reference to the fractured U.S. insurance market, then he is correct to identify that as a problem. Beyond that, his strategy seems to consist mainly of adjectives: wonderful, terrific, etc.
Trump's error is useful to consider inasmuch as he is not the only one who imagines the federal government in the role of master dealmaker in the health-care market. In reality, the main problem isn't a lack of deals but a lack of competitive markets, consumer choice, and transparent prices. Two-party deals between Big Government and Big Pharma are one way to make that situation even worse than it is.
No deal.
You’re not wrong, and neither is the adage “a rising tide floats all boats”. We used to take 3-4% GDP growth for granted, before the punishing regulations and nationalization that has occurred in the Obamanation.
Start by revoking all Executive Orders passed by Obama. ALL of them. If something is important it can be reviewed after the case is made. Then review all congressional legislation that Obama put in place and start the work to repeal it, beginning with Obamacare. Some things can’t be undone by a President alone, no matter what candidates claim - Congress made these laws and Congress is the only one that can un-make them, but President Trump will hasten to make that deal, while the R majority (hopefully) still exists.
Stop giving money to people who are our enemies.
Stop subsidizing things that don’t need to be subsidized, whether it’s an industry, an energy source, a program that isn’t needed or doesn’t produce results, or people who are just leeches on society.
Whoever he picks as VP should have a lot of administrative and executive experience, because if I were Trump I’d put my VP in charge of Government Demolition. Just as “demo” is the first phase of a construction project, he needs to start tearing out the old government that doesn’t work. Replace what might be needed with a “beautiful new government” that does, or put some nice green space in its place (i.e. green money in taxpayers pockets).
If I can see how to do this, you can bet the great advisors Trump has see it. The issue is putting man in charge who will DO it rather than lawyers, politicians, (or both) who will be constrained by the political system they have worked in all their lives.
“If I’m negotiating for health insurance for my people in New York or California or Texas, I usually have one bidder in each state. Competition brings down prices, and the way the law is now, it discourages real competition between insurance companies for customers. They have virtual monopolies within the states.”
Nonsense. Almost all the large insurers are available in just about every state. If Trump was negotiating in New York, then Kaiser, United, Cigna, Aetna and probably all the other major insurers are available.
There is simply no hope for people who don’t want things to get better. It is clear that you are happier complaining than working to improve things, or supporting someone who actually has a record of improving things, and has written down actual plans for improving things.
I want to assure you that when Donald Trump is elected President you will be able to complain about something he does or something he doesn’t do.
Cruz is going to fix it? he tried already. No one followed him. He let everyone else define what he did, even late night talk show hosts
Show where n review has been intellectual on trump
None of those people are going to fix health care. They would not exert constitutional power to fix this system which is now run by huge corporate money which rules over the government
RE: First of all don’t let National Review know any of your plans until after the election.
How much different is this compared to “We have to vote for it to see what’s in it”?
Where is your boy’s ‘detailed’ health plan?
Giving us John Roberts to insure we are stuck with Obamacare was enough.
People ask these kinds of questions for you idiots that think just because you can't think of a way something can be done...it can't be done.
Have any other candidates been asked to explain what they plan to replace obamacare with? Or just Trump
Cruz’s ONE and only legislative accomplishment during his BRIEF career in the US Senate was a bill to stop Iran’s proposed U.N. envoy Hamid Aboutalebi from entering the United States. Since becoming a member of the Most Exclusive Club in the World, Cruz has accomplished little, other than grandstanding speeches to elevate his profile to enable him to run for President, his lifelong ambition.
Sounds familiar doesn’t it?
After National Review’s anti-Trump issue... they basically lost all credibility because they basically announced that every piece they publish will be anti-Trump. That said... I do wish that Trump would come out with more specifics about what he wants to do after repealing Obamacare.
My understanding is that he wants to make it easier for insurance companies to offer plans in multiple states so that more choices will be available and completion may be increased. He also says he wants to encourage “health care savings plans” something that my wife and I have and appreciate. That combined with our Christian Healthcare Ministries “coverage”, is a good solution for us to get around the huge expense of Obamacare both to the government and to individuals.
Unfortunately, our “healthcare savings plan” which was set up by my employer when I retired, has funds added to it every month until I reach Medicare age that were intended to help partially offset our health insurance expenses. Currently, the IRS does not allow these funds to be used to pay the “premiums” of a Healthcare Ministry because they are not considered insurance despite the fact that they serve the identical function. I would like to see this changed, but none of the candidates seem to be aware of the existence of Healthcare Ministries let alone the way Obama stooges in the IRS do everything in their power to make it difficult for those of us who choose the option.
One of the biggest problems with Obama care is that it not only mandates that people buy a plan; it also mandates what coverage must be included in those plans... a bunch of left wing nonsense like forcing all of us to pay for abortions, sex change counseling and surgeries, drug treatment programs, etc. etc. etc... It all sounds good to them, but if you are not a drug abuser why should you be forced to pay for their treatment? If you are not a sexually “confused” pervert why should you be forced to pay for their counseling and treatment?
I wish all the candidates would articulate more specifics on health care... more specifically that the government for the most part needs to get out of the way and let the free market do what it does best... let people and providers work out the most efficient means of delivering the services that are desired.
Right now, every insurance company must meet the requirements of an individual state’s insurance commission. That is a fact. Some of the companies are in multiple states, but the plans will not be the same. If there is a plan in a neighboring state, you can’t buy it.
It is worse now with Obamacare. They have moved the lines down to the COUNTY level. What is available in Tucson is not available in Phoenix.
The lies start in the second sentence. Britain has National Healthcare for the peasants. If you have the money, you can see doctors on your own dime. Britain is not like Cuba, North Korea, or Canada where there is a government monopoly.
If anyone wants to see what a government run health system would look like, go to your local VA.
“Donald Trump doesn’t know what he thinks about health care.”
Guess the writer didn’t watch the debate. Trump gave a well-thought-out response. Free market. Portability. Shopping across state borders. HSAs.
But he “doesn’t know”?
“Get rid of ObozoCare”
Correct. That is the first and most important step.
I wish one of these “expert” fools who writes these Trump hit pieces would take a stop watch and give himself 60 seconds to completely and ultimately explain to everyone’ satisfaction how to correct the nation’s health care system.
Carson, who is a doctor, stepped into the weeds a little too deeply, and pointed out that it cannot be done on a stage such as they had.
I thought Trump did okay using his time allotment.
A year ago I broke my left foot and in every room in ER was a sign saying you would not be refused service due to inability to pay. My co pay of $60 was actually reduced to $45 because we paid at the time of service. The hospital clerk said almost no one pays so this was a way they hope to encourage some payment. Sad that people feel so little self responsibility.
Why?
'cause I was educated (REALLY educated) and had a job
Another NR hit piece. The reality is that no one really has a plan to replace Obamacare. It will be up to Congress to fight it out first to repeal Obamacare (doubtful) and even if successful, there will be a fight about how to replace it with the special interests and lobbyists getting involved. There will be compromises and deals. So this is all a tempest in a teapot.
THAT nonsense again?
It is true that Cruz was supportive of Roberts, as were most Republicans at the time of his nomination. He realized that this was a mistake after the Chief Justice joined the Court's liberals at the eleventh hour to save Obamacare's individual mandate. In fact, Cruz consistently denounced that outrageous ruling during his 2012 Senate campaign. As he put it just after the decision: "This is a sad day for liberty. The Supreme Court has abdicated its responsibility to safeguard the Constitution, and it has rewritten Obamacare in an ill-advised attempt to save it." And Cruz has since bucked the GOP establishment over the funding of the law.
Trump has said, since the day he announced (and even before) that 0care is a disaster, that he’ll repeal and replace with private plans available for purchase across state lines (something we screamed about, thread after thread here, before and during 0care betrayal). He’s also said he’ll clean up all of the MANY levels of red tape between hospitals and insurance companies.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.