by Saurabh Jha
It is possible that in a few months only Nate Silver's prediction models will stand between Donald Trump and the White House. I will leave it to future anthropologists to write about the significance of that moment. For now, the question “What will President Trump be doing when he is not building a wall?” has assumed salience.
This is relatively easy to answer when it comes to health policy. Just ask what people want. Seniors don't want Medicare rescinded. Even the most ardent free market fundamentalist group, the Tea Party, want Medicare benefits; as one of their ranks warned Obama, without a trace of irony, “Government, hands off my Medicare.”
Trump will protect Medicare. Even raising the eligibility age for Medicare is off the cards as far as he is concerned. He has promised that no one will be left dying on the streets. That people no longer die on streets, but in hospitals, because emergency rooms must treat patients regardless of their ability to pay, is irrelevant. The point is that Mr. Trump knows that the public values healthcare. And Trumpcare will show that Trump cares.
But it gets complicated. Yes, the public wants top notch healthcare for themselves. No, the public don't want to die on the streets. Yes, the public wants the government to look after them. The problem is that the public doesn't really want to pay for these services. Not much at least.
How will Trump manage these contradictory desires? Trump recently released his healthcare manifesto. Here are its Seven Pillars:
- Repeal Obamacare
- Allow purchase of insurance across state lines
- Allow people to deduct insurance from taxes
- Expand Health Savings Accounts (HSAs)
- Require price transparency for medical goods and services
- Block-grant for Medicaid to the States
- More free market for pharma
Trump's first test will be repealing Obamacare. It is clear Mr. Trump doesn't like Obamacare. He says about Obamacare that “people have had to suffer under the incredible economic burden.” What will he do about people with pre-existing conditions who insurers must cover by law thanks to Obamacare? Will we return to the days when insurers can turn down patients based on their risk, or yank the premium so high that they cannot afford insurance?
