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.
Get rid of ObozoCare...................
Step 1. WIN the election.
Every hospital emergency room said "you will not be turned away."
Does National RINO Review do anything but put out Trump hit pieces? I know they’re faltering, but is this really their plan to stay afloat?
Their reputation is now that of NYT.
I still say the only reason that was created was to bring communism through the back door. If they wanted socialized medicine why pay for it at all? No instead their plan all along was to get the costs so high that the majority of people couldn’t afford it while at the same time raising the fines through the roof for not buying it until it got to the point where millions of people would be indebted to the government for massive sums. Then the government pulls the rug out and says “A hah, you own us a fortune in fines and you can’t pay it” and they use that as an excuse to take everything you own. Redistribution, collectivism, communism 101, the government owns everything and everybody. To me that’s exactly what is going to happen if Hitlery is elected.
Having said that ... I think it's simple and it is the simplicity he doesn't want to reveal because, well ... it makes all of us look like assholes
Jobs
That's it and that's ALL of it
SS? ... jobs
The economy? jobs
Taxes? .. jobs
Foriegn policy (which almost always translates into $ from us going somewhere else for whatever reason ..jobs
Crumbling infrastructure? .. jobs
The more I think about it, the more I believe, if Trump can get us making steel and shoes and clothing and (whatever) ... we can have full employment, (drop the rate but keep the principal taxes), and cut government intrusion (presence/power) in ordinary American lives ... we will have eliminated 90% of our problems
Even the so-called homeless could lace up widgets if there was a widget lacing factory in someplace city, USA.
He negotiates deals that brings work IN to America
RE: Does National RINO Review do anything but put out Trump hit pieces?
As a Ted Cruz supporter, I don’t mind hit pieces on my candidate, as long as the issues are discussed.
Healthcare is an important issue. Trump has said this and that on it. We’d like to pin him down once and for all.
How about looking a part of Donald Trump’s actual proposals on healthcare?
- - - - - -
As I’ve said, I’d like to see a private insurance system without artificial lines drawn between states. We need to get rid of those lines and let people and companies cross state lines to purchase the best plan for them. The government should get out of the way and let insurance companies compete for your business.
I have a big company. I have thousands of employees. 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. That makes no sense. It’s very stupid and unfair for us.
You know who loves a lack of competition? Those insurance companies, who are making a fortune because they control the politicians. They’ve paid for them with their contributions, and it’s a good investment from their perspectives. For our country, not so much. They give money to almost all the politicians. I’m using my own money so I am free to do what’s right, and serve the people, not the lobbyists.
Nobody understands business better than I do. You want better plans at a better price? Increase competition for customers.
The government doesn’t belong in health care except as the very last resort. The main way the government should be involved is to make sure the insurance companies are financially strong so that if there is a catastrophic event or they make some kind of miscalculation, they have the resources they’ll need to handle it.
If we follow my logic, our health care system, and our economy, will be well again very soon.
Trump, Donald J. (2015-11-03). Crippled America: How to Make America Great Again (Kindle Locations 944-956). Threshold Editions. Kindle Edition.
“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....”
What actually ails American health care is high prices. We pay two or three times as much for the same procedure as they do in Europe. That’s why we spend 20% of out GDP on health care, and they spend less than 10%. If the costs are this high, there is no conceivable scheme of payment that will make health care affordable.
Look at the numbers:
Total health care expenditures: $3 trillion
Total salaries and wages: $7 trillion
Total GDP: $15 trillion
We just can’t afford to pay what we’re paying.
Please confirm that you read the article by pointing out its errors. Thank you.
The best thing to replace it with is NOTHING! Just get the hell out of the way and watch the American free enterprise system take over and return it to the pinnacle of international health service that it was before the political fixers got their grubby payola stained hands on it.
RE: How about looking a part of Donald Trump’s actual proposals on healthcare?
At various times, I hear him say the following:
Replace Obamacare with Health Savings Accounts.
I’m for vaccines, but in smaller quantities to avoid autism.
The insurance companies have total control over politicians.
We didn’t have a free market before ObamaCare.
ObamaCare is a catastrophe that must be repealed & replaced.
Don’t cut Medicare; grow the economy to keep benefits.
ObamaCare deductibles are so high that it’s useless.
Save Medicare & Medicaid without cutting them to the bone.
Increase insurance competition across state lines.
He Flew sick kids cross-country on his private jet.
We must have universal health care. (Jul 2000)
I agree with him on at least two proposals: HEALTH SAVINGS ACCOUNTS and COMPETITION ACROSS STATE LINES.
How he plans to give Universal Healthcare is something he needs to explain.
Well said. I never thought of 0 care that way.
National Review writers are like a bratty two old crying on the floor because it is not getting its way with Trump and his voters.
Let them and their dwindling supporters act like two year old brats laying on the floor screaming. Eventually, they will get over it.
Yes win the election then seriously start working on fixing things. Nobody running has a total healthcare plan all worked out. Vote for who you think is the best problem solver and let them get to work.
I’m voting for Donald Trump because I think he’s the one. I don’t care about playing golf with the guy or going out to dinner with the guy on Friday night.
Sorry. It’s just not a deal breaker. The medical system in this country has been broken for over seventy years since third party payer came in promising to take responsibility for one’s health and that of one’s family away from the individual and the family. Then government came in with Medicare for this purpose
Then Medicare was bankrupted by doctors and other administratively, fiscally clueless health care workers misnamed for tge sick care system we now have where tge health of the average citizen is ridiculously below average and we have total dependence on the pharmaceutical industry
Obam came in and took advantage of it like any parasitic person would. No one up there who is not trump is going to fix it especially if (?) insurance or pharmaceuticals are donors. National review is just spewing again
I see national review and I don’t have to read tge article.
When people don't have to pay a dime for healthcare services, the system is overwhelmed by abusers and the system collapses and that's what's going on. Everyday, millions of freeloaders abuse the healthcare system simply because it doesn't cost them anything not to.
Most people have no idea how widespread this abuse is and what a problem it is for the system. It is massive.
First of all don’t let National Review know any of your plans until after the election. They are a den of vipers that are trying to bring this country down along with Obama. National Review wants a yes man to be President and not a leader.
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