Where Is the Trump Health Plan?
Terry H. Schwadron
Dec 27, 2019
Just as he has been impeached, Donald Trump has been handed his crown jewel.
A week ago, the hand-picked federal appeals court in Texas has torn the heart out of Obamacare, declaring the clause that mandates health coverage as unconstitutional.
The court panel voted 2–1 to send the case back to a lower court to review the details of whether all, some or none of the rest of the Affordable Care Act can survive.
At stake, of course, is health care coverage for about 20 million.
Having gotten the Department of Justice to turn itself inside out to argue against the existing federal law in the case, you would think that Trump would now find himself seeking to be the author of a new health law that would succeed Obamacare.
But no, we hear the repeated promised that his administration can devise a magic way to produce health care coverage that is available to all, that does not discriminate against those with pre-existing health problems, that includes mental and physical care as well as keeping coverage for offspring through age 26, that is supported by insurers, health professionals and doctors — all out of whole cloth.
It is the same gold cloth that covers a president whose policy-making skill is naked.
The court case in question is one that examined whether it was constitutional to demand that every household in the country have health care or pay a fine if they did not buy it. Based on that idea, insurers were willing to sell coverage that met the specified standards even in rural or less accessible parts of the country. Without it, insurers said they would lose money and they would not offer insurance.
Trump joined the chorus of Republican antipathy for a health law that mandates anything, but has never come up with an alternative. Those approaches he has half-heartedly endorsed along the way offer cheap health insurance to the healthy, that do not cover the important and expensive parts of health care, or those that depend entirely on employer-paid insurance. At the same time, he has criticized the cost of health care for companies as well.
To set up this current case, Trump and Republicans in Congress cut the fine for missing the mandate to zero. That meant there was no punishing “tax” for non-compliance. As a result, they said, there was no meaningful mandate.
Some 21 states joined with Texas in opposing the law, those most of the rest joined with California in seeking to keep the law. The case went to a Texas federal court, and will end up for a third time before the U.S. Supreme Court, which has reluctantly upheld Obamacare as lawful in two previous, narrow decisions. Chief Justice John Roberts Jr. has argued for the majority that the court does not want to set health policy for the United States.
But Trump says he does, although neither the White House nor Republicans in the Congress have done so over a decade.
Meanwhile, Democratic candidates for president have fallen over themselves to argue that Obamacare does not go far enough and are arguing about which flavor of public health options would work most effectively.
The detailed review of the problem required by the court decision probably means that there will be no demise for Obamacare before the November, 2020 elections. Still, you can expect to hear plenty from Trump about how the court found a bill named for Barack Obama to be unconstitutional.
Don’t expect that Trump or the Justice Department or even those people connected with Health and Human Services to come up with workable alternatives.
The political discussion is only about money and taxes in particular, not about health. And, as the discussions about prescription drug pricing have continued, for example, the voices of Big Pharma match closely with the Cabinet appointees who came from those very industries. Hospitals want to become larger and larger conglomerates to increase the chances of profit, doctors want freedom to charge ever-increasing fees, and, in any case, depend on a growing number of medical tests that improve diagnosis but boost prices. Republicans want health that pops up from the magic marketplace, so long as no one can have an abortion.
The point is that the health care discussion is totally out of control, with the cost of insurance being discussed separately from the prices being charged, with the polemics of politics dominating a discussion that should be focused on services, and with political one-upmanship standing in for rigorous problem-solving.
Where is the role of public health, of the removal of bad water sources and lead paint, for housing and food programs that keep people sheltered and fed, that encourage anti-obesity and good mental health? Those are never part of these challenges to an Affordable Health Act? Nor is there any accounting from a health perspective for the general growth of a gig economy as compared with 30- and 40-year careers with a single employer.
Trump should be forced to confront the realities of his campaign to undercut Obamacare with a workable alternative.
Lets make America Healthier.