Donald Trump’s Big Lie on Health Care

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I realize that criticizing a Donald Trump policy is pointless, but Trump’s health care “plan” deserves a bit more attention. Say what you will about his immigration policies, but at least his written plan more-or-less matched his rhetoric. His health care plan doesn’t even come close. Here are its six proposals:

  1. Allow insurance companies to sell policies across state lines. Whatever you think of this idea, it only makes sense if you can truly buy a policy that’s regulated by another state. Ramesh Ponnuru: “But the plan says that people should be allowed to buy insurance out of state only ‘as long as the plan purchased complies with state requirements.’ That defeats the whole purpose of the reform, and means either that Trump is coming out for the status quo or that whoever wrote his plan garbled it.” Or that Trump has no idea what he’s talking about.
  1. Allow individuals to “fully deduct health insurance premium payments from their tax returns.” This may or may not be a good idea in concept, but implementing it as a deduction makes it meaningless for nearly everyone at the median wage or below. They already pay little or no income tax, so a deduction does them no good. This is why other Republicans have proposed doing this as a tax credit, which would benefit anyone. Even conservatives agree about this: “That’s not going to help,” said Joe Antos, a conservative health policy expert at the American Enterprise Institute.
  1. Allow individuals to use HSAs. Individuals have been allowed to set up HSAs since 2003. The only new wrinkle in Trump’s plan is that an HSA can be used by any family member. This is trivial.
  1. Price transparency. This is fine. It won’t do much to improve health care, but it’s a good idea.
  1. Block grant Medicaid. This would accomplish nothing except, probably, to make health care worse. States tend to do everything they can to use Medicaid dollars for non-health purposes, and giving them total control over Medicaid would only make this worse. Also, it would eliminate the automatic increase in Medicaid spending during recessions, when it’s needed most. Overall, this proposal would almost certainly result in less Medicaid spending and less effective Medicaid spending.
  1. Allow importation of prescription drugs. This is fine.

Trump has been extravagant in his promises about health care: “I would end Obamacare and replace it with something terrific, for far less money for the country and for the people.” He’s said that he would cover everyone. He’s said he would cover pre-existing conditions. He’s said he wouldn’t let people die in the streets. He’s said he would allow Medicare to negotiate drug prices.

His plan includes none of that. He just flatly hasn’t kept any of his promises. Instead he’s offered up something that looks like a fourth grader cribbed it from other Republican plans without really understanding what they said. Even by GOP standards—which is a very low bar—his health care plan offers virtually nothing of substance. It’s completely hollow.


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