And That's How Donald Trump Solved 'Healthcare'
By: Doktor Zoom
S E E D E D C O N T E N T
It'll be great, fuck it, why not.
Donald Trump has been spewing random thoughts on his fake Twitter account again, and because Dear Leader's whims apparently have the force of law, once-respectable media organizations are writing about whatever dumb shit comes out of his facehole as if it were truly "policy." Which of course makes the dumb rants more likely to become policy, because so many people are sure that anything Great Leader says is a terrific idea. Please never mind that the rants erupted from Trump's rage over the government shutdown, which thanks to eight feckless "moderates" is likely to be over before any of Trump's ideas can be turned into action.
On Saturday, Trump shat out a great idea for reforming healthcare: Eliminate the Affordable Care Act, and then take the money that partly subsidized premiums for Obamacare's individual policies and just distribute it to people so they could make *their own* healthcare choices.
Presumably the folks freed from the tyranny of Obama care would go, one by one, to purchase insurance from the same "money sucking Insurance Companies" Trump wants to cut out of the system. Or maybe the money would go to an individual health savings account people could use to pay for part of one serious accident or illness and then go bankrupt. Or maybe it would be that one-time payout of $2000 Trump also blurted about, and people could buy insurance for their entire family (as if!) or just blow it on paying other bills and hope they never get sick. Or maybe Republicans will just kill off the ACA and nobody will get any payout, that could be it, too.
Instead of treating Trump's ignorant rants as ignorant rants, news outlets dutifully reported that Trump had issued a serious policy proposal about healthcare that he expects his underlings to put in place. Will those "proposals" have any life expectancy beyond the end of the shutdown? That depends on where Trump's whims go next.
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Here's CNN taking Trump seriously on the ACA subsidies rant:
President Donald Trump has floated a proposal to put the billions of dollars that back Affordable Care Act tax credits directly in the pockets of Americans instead, as lawmakers have so far failed to find a solution to address the rapidly approaching expiration of the enhanced subsidies that is at the heart of the record-breaking shutdown stalemate.
Trump urged Senate Republicans in a Truth Social post on Saturday to send the money used to offset the costs of ACA health care premiums "directly to the people" so they can "purchase their own, much better, health care."
The Washington Post similarly reported that Trump "urged Senate Republicans to redirect funding for Affordable Care Act subsidies away from health insurers and toward average Americans," and framed it as a tactic to pressure Democrats into voting to end the shutdown.
And because there's no idea too stupid for Republicans, both stories reported that Sen. Rick Scott (R-Medicare Fraud) claimed on Twitter that he was "writing the bill right now" (archive link). Scott may have been referring to a stupid idea he mentioned in late October, which would magically replace ACA subsidies with cash to current ACA enrollees instead. Scott gushed to Fox Business's Maria Bartiromo, "We could fix health care pretty simple. Let's just say, let people buy what they want to buy. If you're entitled to a subsidy under the original Obamacare, give it to you in cash so you're a buyer of health care." That way, he claimed, people "can buy health care cheaper many times if you just go buy it yourself, rather than go through an insurance plan," even though that has never actually been the case in the real world.
On Sunday, Trump claimed in another Truthshart (archive link) that the ACA subsidies could be redirected to the individual health savings accounts (HSAs) set up by the shitty Big Blowjobs for Billionaires bill, although of course the post was short on details about who would qualify and how any of it would work. Trust him.
Remember, nobody has any idea if any of it adds up to a "plan," or even a concept of a plan, or whether Donald Trump intends to support Scott's half-baked idea. But the vague outlines sound similar, so now Politico is reporting that Republicans are — maybe! — "pivoting" from extending the existing subsidies for ACA premiums to offering a whole new healthcare system instead, and one idea they're pitching is "the creation of new health savings accounts."
Never mind that making millions of Americans individually pay for healthcare would abandon the risk pool price savings of insurance as we know it now — to say nothing of the greater efficiencies of a good universal coverage system that negotiates standard provider costs. As MSNBC notes,
GOP policymakers have often championed HSAs because, in theory, they reflect Republicans' preference for individuals' choices over government intervention. In practice, HSAs tend to benefit people with higher incomes: They're the ones with the means to contribute to the accounts, and because they're in higher tax brackets, they benefit more from each dollar saved. Furthermore, researchers at the Center on Budget and Policy Priorities find that HSAs do not significantly benefit those who struggle with health care costs, and relatedly, that they exacerbate the racial disparities the ACA has effectively reduced.
It's all just vapor at this point, but that's the magic of Trumpian vagueness. He tosses out a ridiculous brainshart like "let's give individuals all the ACA subdsidies," and his minions dust off whatever Heritage Foundation white paper they've been hoping to push.
The flavor of the day just might be HSAs for everyone! Or maybe just for everyone now on the ACA. Or maybe most of the funding for ACA subsidies will be redirected to deporting people, and a few scraps will provide seed money for accounts that anyone can "choose" to buy into, if they can afford it.
Whatever rough beast slouches out of Trump's shutdown-driven half-idea, if any, will find a way to eliminate the fairly effective but flawed ACA, and make healthcare shittier for most Americans, but more profitable for whoever provides the next flavor of snake oil. You can bank on that.
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Why not just keep everything as it is except for one thing: change the name to Trump Kingcare. He’d go along with that in a heartbeat, and his cult would have no choice but to say thank you sir may I have another.
Republicans are trying as hard as they can to just return healthcare to the even more broken, more expensive system that had millions of fewer people with insurance. They want a system that only works for people with excess money.
the shell game of private healthcare is the last vestige of questionable financial accountability for wealthy white collar criminals.
I think everyone should have the option to open and HSA not tied to any policy. I wish I could have one and use it to pay my VA prescription copays and things I need that I currently get OTC.
As far as Trump giving back money... the people who truly need it would run thru the payment in the first couple of months and then go right back into medical debt.
As far as Trump giving back money... the people who truly need it would run thru the payment in the first couple of months and then go right back into medical debt.
It is unfortunate that many of them would end up with the latest iPhone and a new car lease.
It’s hard for me to unilaterally feel sympathy for SNAP recipients. Apparently there is not a single thing in their budget that they can adjust to be able to temporarily feed their family without assistance? To be as dependent on government for food as Democrats want everyone to believe is so dystopian. New cell phones, streaming services, Starbucks, nice cars, restaurant dining, etc - these things seem to be ubiquitous among all levels of income. Health insurance is a different story though. It’s unaffordable to anyone who doesn’t have a job that provides it.
There is no doubt poor people spend money on things they cannot afford, that is beyond question. But why do they do that? Because they live in the most extreme consumer culture in history. People's sense of self worth correlates to how big their tv screen is, and that only scrapes the surface. Unless you have the latest whatever you are a waste of space to the people who sell shit 24 hours a day.
That may be the case too a certain extent but there is still the "spend within your means" concept that must be adhered to. No one said it will or should be easy but we shouldn't rationalize it for the ones that do not do it and give them a free pass.
I’m not rich and I’m not poor, but I have experienced poverty in my life. However, I have never had a problem with being a waste of space for advertisers. I despise ads. They are nothing more than obstacles on my screen that I need to keep my fingers clear of while I scroll, and most of what I watch on tv is recorded so that I can fast forward through the commercials. My cable provider even has “smart resume” which automatically stops the ffw at the end of the last commercial. My wife refuses to cut the cord for that reason alone. I get pissed when I accidentally touch an ad on my phone and get directed away to some sales site. It makes me wonder, who is doing that on purpose?
One of the hardest things for me when I was teaching my elderly father about using the internet was ignoring all the ads. I was lucky I never taught him how to actually make purchases.
Everyday , and I mean every day, time on the daytime talk shows like Good Morning America, the Today Show, and The View is given over to blatant advertising, by the hosts, for products that people are told they really need. Fancy face creams, luxurious sheets, the latest luggage, and on and on and on. They dont tell you you are watching an ad, they act like they are doing you a favor in connecting you up with the good stuff. People who cant afford that stuff are buying them because they want to keep up with the Joneses. Of course poor people watch those shows too.
I have a sister who is divorced and lives by herself. She is by no stretch poor but her only income is social security, although she does have considerable retirement savings. Although she is 69 now, she doesnt want to go into her retirement account for day to day living expenses at this point.
Still she watches these shows and buys things she sees on them just because they look good and Oprah says so. This is the classic effect of advertising.
Some people. Many people.
But as I'm sure you are aware, that's not true of all people!
People's sense of self worth correlates to how big their tv screen is, and that only scrapes the surface
Some people. Many people. But as I'm sure you are aware, that's not true of all people!
(Perhaps you're hanging out with the wrong crowd)?
Originally the 2000 dollars to everyone scheme was meant to address the "affordability" issue, and paid for by the "trillions" coming in through tariffs, but since health insurance became a hot issue, the fantasy of the 2000 dollars is being rerouted to that purpose. None of it is real.
This was the GOP's plan during Obama. The HSA's gave the patients control over how the money was spent which allowed shopping around to get a better price for the service needed and just that act alone would cause a price drop for medical procedures and products, however you were still required to purchase catastrophic insurance with a high deductible (the HSA would cover the deductible, copays, OTC, dental, vision, etc. as the patient deemed necessary or even out of pocket from the premium savings), but the catastrophic insurance would save the people thousands in premiums/year.
The democrats wouldn't go for it, too much patient control and not enough government involvement.
You're right, we should be allowed to do this now as an option using pretax payroll deductions and matching employer payments.
The other side of this problem is there is really no transparency in pricing for healthcare. The best you can get is the "out the door" price for a procedure based on no insurance being used. The providers cannot give you a quote for insurance as that is actually proprietary information based on the contracts the health insurance company signs with the provider. I remember a simple study done in Cleveland where they were looking at the cost of a hip replacement. Simple standard surgery that is performed several hundred thousand times a year just in the US. It's a well-known procedure. But the price range in just the city of Cleveland ranged from $13k to $87k. It's not like buying a loaf of bread where you will see prices close together at multiple stores.
Without transparency there is really no way for the consumer to shop for better pricing. It's just a feel-good sham run by insurance companies.
The price range is because each insurance carrier negotiates pricing. It's insane... then their is what's called provider based billing in which hospitals can add a facility charge not covered by Medicare - so most gap insurance doesn't cover it either.
GWB.
They started in 2004.
Tying it to a policy was a concession to get Democrats on board. Otherwise HSAs just turn into a tax dodge for rich people.
I know... I just don't agree with it. It was also the Dems that limited what people could use them for.
I don't mind the cap. Rich people still use them, my old boss used it to sell High Deductible Health Plans to rich people. You can individually put up to $4,300 or $8,550 per household though people over 55 can add an additional $1,000.
If you had it who wouldn't use it to not pay taxes on almost $10K?
Health care is currently a disaster. Throwing more money at a failed system is not the answer. It is like getting a new transmission on for a car with 250,000 miles on it. At a certain point it is time to get a new plan. And while you are coming up with a new plan look at the number of illegals getting free healthcare because they can use emergency room care as a doctors office anytime they feel sick.
Even though it is claimed by many the US has the best HC in the world? It might behoove the Land of the Best to bury her hubristic navel gazing and take some serious notes from other nations. Yes you will find there are critics in those other lands but no system will make everyone happy.
If you are talking about the quality of healthcare I agree. If you are talking about the cost of healthcare we are far from being the best. We need to figure out how to pay for it without raising taxes by 10 percent or so or waiting months to see a specialist. I won't say it will be easy but I will say it seems no one is seriously working on it.
Navel gazing seems to often win out.
People come to the United States from all over the world seeking higher quality care.
People leave the United States to seek cheaper care.
Morning Jack...I for one really don't understand the US health care system and the way it seems to pick and choose who gets what and how much..
Just this morning two hours ago, it was announced which is to my extreme benefit, a new drug that treats multiple myeloma has gone from $13,000 a month to $25..
It makes no difference if you have health insurance or not, it's $25 for everyone.. it's gone onto the PBS and the insurance companies and drug companies have no say in it.
Why would you make it harder for your own people when drugs can be obtained at a reasonable cost even if they are from overseas??
They are playing with people's lives...and that is beyond contempt...
It's interesting. Let's start with the fact that most of the horror stories you hear are repeated because they are aberrations. There is nothing remotely interesting about a story of something that happens a million times a day. Most of those stories are also retold by people who don't understand insurance, so things get misrepresented.
I'm not sure that our system is unique, but it's certainly different from most other developed countries. Much of this goes back as far as WWII and the economic aftermath.
The US never experienced the destruction that places like GB or France or most other major European countries did, so we weren't forced into nationalizing healthcare. In the years that followed, our national fear was communism and the Cold War, so we tended to be very zealous in our preservation of private enterprise.
So the delivery of healthcare evolved with emphasis on private practices and private hospitals, and all of the legislative decisions along that way have expanded that model.
As a result, American physicians are the highest paid in the world. American hospitals are the most expensive in the world. Drug company profits in the US are orders of magnitude higher than they are anywhere else.
When we enacted it in 1965, Medicare was projected to be a $2 billion program by 1980. It was actually $60 billion.
The cost of care itself has been spiraling out of control for decades, and our government has limited mechanisms for controlling that and very limited courage at using them. It's not like the UK, where all the major hospitals are government owned or Canada where all the citizens are on the same healthcare plan that just tells providers what they'll get paid.
What makes matters much worse is the structure of our Congress. Most of the actual drafting of legislation is done by congressional aides, most of whom are kids in their mid twenties who majored in political science because it didn't require any math classes. (My daughter in law is a great example)
The career path for a congressional aide is college => internship => junior staffer => senior staffer/policy lead => law school => big law firm => 30th birthday.
So we're looking for governance or regulation over complex actuarial programs by 26 year olds who can't even do trigonometry. (which is actually remedial math)
But the primary issue here is that most of us figure it out. 80+% of us have some form of insurance, usually employer based. Most of us go to the doctor for a $20-$50 copay, most of our medications are covered for a $10-$100 copay, and most of us have no trouble getting very excellent, Rolls Royce level hospital care.
Until there is a national point of pain that the majority of us refuse to tolerate, things are going to continue pretty much as they are.
They are playing with people's lives...and that is beyond contempt...
Of course they are. It’s all about profit here, never about cures. A drug that will marginally keep you alive priced at what that unfortunate market will bear is a thousand times more valued as a cure. You should see our commercials here. Drugs that cost thousands for a prescription here are relentlessly advertised, because who cares about the expense of a massive advertising campaign when you can just pass it on to the patient? It reminds me of these “charities” that spend the majority of their donations on advertising and operating costs, so that the administrators can have an income for managing their useless charity.
I don't get it. Trump spouts off some TEA Party and Libertarian nonsense and somehow that magically becomes an endorsement for Obamacare?
Look, Democrats shut down the government because ACA is in such dire straits that loss of expanded subsidies will cause insurance premiums to double or triple. That's not a minor glitch that requires a few tweaks. When do we finally acknowledge that the ACA is just a Band-Aid and not a solution. The problem of affordable healthcare has not been an insurance problem and trying to fix insurance is not a solution.
We've had Obamacare for a little over a decade and healthcare is still unaffordable, access to healthcare is still tenuous, and healthcare deserts are still expanding. Obamacare is not delivering what was promised. Not even the gross harm caused by a government shutdown can hide the failure of Obamacare.
Well of course healthcare is outrageously expensive in the country that refuses to nationalize healthcare - preferring instead to let soulless shareholder capitalists and hedge fund managers set the prices for goods, services, and pharmaceuticals that are inherently highest on a human’s priority of needs. Literally your money or your life.
Both Obamacare insurance and expanded Medicaid (under Obamacare provisions) are forms of nationalized medicine that subsidize profits in healthcare. People seem for forget that Obamacare included provisions that require employers to provide (and subsidize) health insurance for employees, too.
So, there needs to be some clarification of what is meant by nationalized healthcare.
Two Week Healthcare Plan? Or Too Weak Healthcare Plan?
Republicans have failed to develop anything resembling a healthcare plan since ACA\Obamacare was passed.
For Republicans it was far easier to complain, blame, evade, take their salaries and their own government healthcare while never intending to fix anything or create their own solution for Americans.