Donald Trump finally released his position paper on health care reform this week, clarifying and strengthening what had been a liability, one that his major opponents, Ted Cruz and Marco Rubio, had mocked for its inconsistencies and assertions.
As a practicing physician who has studied and been victimized by the damaging effects of ObamaCare, I was glad to see Trump define his position. I am on the lookout for any plan that aims to undo the worst of ObamaCare: spiraling premiums, limited access to providers, high deductibles that hamstring poor and middle-class patients and heavy federal subsidies and related tax hikes.
Complex candidate position papers are standard fare, but the fact is that little or none of their detail will be utilized when the election is over. So I’m more interested in broad brush strokes at this point, and the American public should be too. With this in mind, let’s examine the essential bones of Trump’s health care plan, even if it lacks the flesh of the other candidates’. He released seven key points:
1. Repeal and replace. Trump has said this repeatedly, and it carries more weight now than previous threats thrown at President Obama’s veto pen. The Health Care Choices Act, authored by Cruz and co-sponsored by Rubio last year, included central aspects of both senators’ positions: the ability to buy health insurance across state lines and eliminating the mandate to buy insurance, the insurance marketplaces and federal subsidies. But it had zero chance of becoming law. “Repeal and replace” can become a reality only if a Republican wins the presidency.
2: Modify the law that inhibits the sale of health insurance across state lines. “The lines, the lines,” Trump says on the stump, referring to removing the ban, not to the growing waiting lines in doctors’ offices. Like Rubio and Cruz, Trump favors portability of health insurance from state to state. As a mega businessman, he knows this will introduce more competition into the system and drive premiums down. If, for example, Nevada offers a cheaper yet equally effective insurance product as New York, my patients could buy it there and use it here.
3: Allow individuals to fully deduct health insurance premiums on their tax returns. Businesses take these deductions, so why shouldn’t individuals? This will help people who previously couldn’t afford insurance to buy it. Rubio, too, has backed the idea of tax incentives to buy health insurance.
4: Health Savings Accounts. Trump proposes to expand this program. Contributions should be tax-free and be allowed to accumulate and become part of the patient’s estate. Health savings accounts work well in the doctor’s office, as a patients are more aware of what services they’re getting and what they’re actually paying for them.
5. All prices should be transparent. Patients should be able to shop for the best prices for procedures, examinations, etc. This will help drive prices down to a more affordable range. Right now, something like an echocardiogram is far more expensive at one hospital than another. xxxx
6. Block-grant Medicaid to the states. States know their people the best, Trump says, “and can manage the administration of Medicaid without federal overhead.” Rubio, too, recommends block grants. But Trump refused to denounce Medicaid expansion in New Hampshire when he was campaigning there. He has said repeatedly, “I will not let people die on the streets.” His plan doesn’t take into account that Medicaid is an expensive and inefficient state-administered insurance plan that has a narrow network of doctors and badly needs an overhaul. Simply expanding it, the way ObamaCare does, or handing over full responsibility to the states is not the best solution. Perhaps a more informed Trump will come to see this.
7. Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Trump believes special interests are driving up prices, and he wants consumers to be able to import drugs, which will drive prices down. He has also said that Medicare should be able to negotiate prices, a controversial change. Since Medicare frequently sets the standard for prices in the industry, this makes sense – especially when it comes to the overinflated prices of new cancer and heart drugs. Rubio proposes reforming Medicare by transitioning to a privately funded premium support program intended to control costs while maintaining services, though prior efforts to privatize Medicare have failed. Cruz would raise the Medicare eligibility age, which I believe is a good idea.
In a Feb. 18 interview with CNN, Trump indicated he would keep ObamaCare’s individual mandate, which makes you pay a fine if you don’t have health insurance. But the next day he tweeted that he would remove the mandate (a central piece of ObamaCare) and install a “backstop for pre-existing conditions.” His positions on health care seem to be evolving as he learns more. In this week’s position paper, it is clear that he intends to get rid of the individual mandate. During last week’s debate, he flatly denied Cruz’s accusation that he wants the government to pay for everyone’s health care. Perhaps Trump would have agreed with President Richard Nixon, who in 1974 proposed a comprehensive health reform plan that included cost-sharing health coverage, subsidized by the federal government, for poor Americans. This plan probably would have passed, if not for Watergate.
Trump’s position paper on health care goes on to say that enforcing immigration laws will relieve economic pressures. His wall would theoretically help out hospitals in the South and Southwest that are overburdened by the costs of services they provide to illegal immigrants who can’t pay for them. Meanwhile, the heroin trade is burgeoning, with 300,000 more users than a decade ago and over 10,000 overdose deaths per year. Decreasing these numbers would decrease U.S. health care costs substantially.
So Donald Trump has a health care plan. It needs more flesh on its bones, but at first glance it is not as reckless as his main opponents (both huge ObamaCare critics) say it is. Trump promises to reverse at least some of the damage ObamaCare has done to my patients and me. I believe that if he’s elected, he’ll try.
Marc Siegel MD is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a medical analyst and reporter for Fox News since 2008. His upcoming book concerns a mysterious viral outbreak.