Friday, January 13, 2017

Donald Trump’s Medical Delusions

Photo
CreditLuke Sharrett for The New York Times
Thanks, Comey.
The Justice Department’s inspector general is now investigating the way the F.B.I. director conveyed the false impression of an emerging Clinton scandal just days before the election, even as he said nothing about ongoing investigations into Russian intervention and possible collusion with the Trump campaign. That action very probably installed Donald Trump in the White House. And it’s already obvious that the incoming commander in chief will be a walking, tweeting ethical disaster.
On the other hand, he’s also dangerously delusional about policy.
Some Republicans appear to be realizing that their long con on Obamacare has reached its limit. Chanting “repeal and replace” may have worked as a political strategy, but coming up with a conservative replacement for the Affordable Care Act — one that doesn’t take away coverage from tens of millions of Americans — isn’t easy. In fact, it’s impossible.
But it seems that nobody told Mr. Trump. In Wednesday’s news conference, he asserted that he would submit a replacement plan, “probably the same day” as Obamacare’s repeal — “could be the same hour” — that will be “far less expensive and far better”; also, with much lower deductibles.
This is crazy, on multiple levels.
The truth is that even if Republicans were settled on the broad outlines of a health care plan — the way Democrats were when President Obama took office — turning such an outline into real legislation is a time-consuming process.
Continue reading the main story
In any case, however, the G.O.P. has spent seven years denouncing the Affordable Care Act without ever producing even the ghost of an alternative. That’s not going to change in the next few weeks, or ever. For the anti-Obamacare campaign has always been based on lies that can’t survive actual repeal.
A prime example is the pretense that health reform hasn’t helped anyone. “Things are only getting worse under Obamacare,” declared Paul Ryan, the speaker of the House, last week. Yet the reality is that there has been a dramatic reduction in the number of Americans without insurance since reform went into effect — and an overwhelming majority of those covered by the new health exchanges are satisfied with their coverage.
How have Republicans nonetheless been able to get away with this lie? Part of the answer is that many of the newly insured don’t know that they’re being covered via Obamacare, or at any rate don’t realize that they will lose coverage if it’s repealed.
But that will change if repeal proceeds. For example, the percentage of nonelderly white adults without insurance fell by almost half from 2010 to 2016, from 16.4 to 8.7, a gain surely concentrated in the Trump-supporting white working class. Repeal would send that number right back up, and there would be no hiding the damage.
Meanwhile, Republicans have made hay over this year’s increase in insurance premiums. But this looks very much like a one-time adjustment; and the broader picture is that health costs have actually gone up much more slowly since Obamacare was enacted than they did before, in part due to the law’s cost-control features, which have worked far better than most expected.
And if the Affordable Care Act is killed, myths about its costs will be replaced by the reality of soaring bills for millions of Americans who don’t realize how much the act has helped them.
But won’t Trumpcare solve all these problems, by offering something much better and cheaper? Not a chance.
Republicans don’t have a health care plan, but they do have a philosophy — and it’s all about less. Less regulation, so that insurers can turn you down if you have a pre-existing condition. Less government support, so if you can’t afford coverage, too bad. And less coverage in general: Republican ideas about cost control are all about “skin in the game,” requiring people to pay more out of pocket (which somehow doesn’t stop them from complaining about high deductibles).
Implementing this philosophy would deliver a big windfall to the wealthy, who would get a huge tax cut from Obamacare repeal, and it would mean lower premiums for a relatively small number of currently healthy individuals — especially if they’re rich enough that they don’t need to worry about high deductibles.
But the idea that it would lead to big cost savings over all is pure fantasy, and it would have a devastating effect on the millions who have gained coverage during the Obama years.
As I said, it looks as if some Republicans realize this. They may go ahead with repeal-but-don’t-replace anyway, but they’ll probably do it because they believe they can find some way to blame Democrats for the ensuing disaster.
Mr. Trump, on the other hand, gives every impression of having no idea whatsoever what the issues are. But then, is there any area of policy where he does?

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