Long before Mr. Trump published his health care plans on his campaign web site on March 1, 2016 he outlined his plans in both of his books “Time To Get Tough” from 2011 and his latest book “Crippled America” from 2015. I have linked the pertinent sections pertaining to Mr. Trump’s health care policy proposals as outlined in those two books below.
Contrary to a popular but false narrative, Mr. Trump does not propose a “Single Payer Socialized Medicine” plan now nor did he propose such a plan when he first penned his actual plans in his book “Time To Get Tough”. As you read through chapter 8 of “Time To Get Tough” and you read through chapter 7 of “Crippled America” you will not find Mr. Trump calling for a “Single Payer Socialized Medicine” health care plan anywhere. In fact, in chapter 7 of “Crippled America” you will find that Mr. Trump specifically disavows his tepid and earlier consideration of a Single Payer system as one of the options he was considering as a person in the private sector more than 15 years ago. Mr. Trump starts his plan with repeal and replacement of the PPACA a.k.a. “Obamacare”. This begs the question, replace with what?
In both of Mr. Trump’s books he calls for the following private sector reform alternatives. Some of which are also called for under Dr. Ben Carson’s plan among others. In addition to federal and state reforms, they include:
1.) Repeal of the McCarran Ferguson Act so health insurance can be sold across state lines.
2.) Expansion of Health Savings Accounts to promote price transparency & accountability.
3.) Tort (or Medical Malpractice Reform)
4.) Reform of our health care safety nets including block granting Medicaid back to the states so states have more control.
5.) Mr. Trump has most recently added necessary reforms to be made to our broken Veteran’s Administration health care system specifically because it, like all other Single Payer systems is an unmitigated disaster!
“But Steve, Trump said he wants “Universal Healthcare! I heard him say it on CBS!!” Yes, he did. So what does Mr. Trump mean by “universal” healthcare? For that we simply have to look up the definition of the word ‘universal”. According to Miriam Webster’s dictionary the term “universal” means “existing or available for everyone”. That does not mean ‘Single Payer’ nor does it mean ‘Socialized Medicine’. It does mean a health care system where everyone has access to some form of health care delivery. That is what I want. That is what nearly every politician on both sides of the isle wants. Affordable access to health care services for everyone. How do we do that? When it comes to Medicaid, you can look to former Governor Mitch Daniel’s reforms that worked in Indiana or more recently to Governor Scott Walker’s reforms that were made in Wisconsin. There are other ideas also.
Most importantly when it comes to the vast majority of Americans this is what Mr. Trump actually said at the end of chapter 7 of “Crippled America” and I quote:
“The government doesn’t belong in health care except at the very last resort. The main way the government should be involved is to make sure the insurance companies (not a top down, authoritative single payer health care system) are financially strong so that if there is a catastrophic event or they make some kind of miscalculation, they have the resources they need to handle it.”
Mr. Trump also said in the beginning of chapter 7 of “Time To Get Tough” and I quote:
“..we still need a plan to bring down health care costs and to make health care insurance (not a top down, authoritative Single Payer health care system) more affordable for everyone. It starts withincreasing competition between insurance companies. Competition makes everything better and more affordable.”
Providing a safety net is NOT a “Single Payer Socialized Medicine plan for all Americans“
But Steve! Trump said “the government is going to pay for it.” I saw it on CBS!” Yes, he did. Firstly, the government pays for nothing. It confiscates wealth from taxpayers and redistributes it. Secondly, we taxpayers already pay to provide health care services to millions of our nation’s indigent and those who are developmentally disabled. Some of the health care programs that ‘the government pays for’ include:
1.) Ronald Reagan’s E.M.T.A.L.A which requires every hospital that accepts Medicare and Medicaid (which is nearly all of them) to care for any patient who presents with an emergency “regardless of their ability to pay.” Oh my gosh! Reagan was a SOCIALIST!??
2.) Medicaid which provides either taxpayer funded access to health care services or subsidized private health insurance on a sliding income scale for the indigent and the developmentally disabled.
3.) S.C.H.I.P which was a bipartisan piece of legislation written to ensure that children of parents – who make too much to qualify for Medicaid but too little to afford private health insurance – have access to health insurance on a sliding income scale.
We also subsidize programs such as Medicare Part C & D and other health care programs. We will continue to do so because Americans are compassionate people who seek to help those who aretruly in need. I say truly in need because under the PPACA (Obamacare) we expanded Medicaid to single adults without children who happen to fall below 138% of the Federal Poverty Level. In doing so we robbed those finite resources from single mothers and the developmentally disabled. That is not helping those who are truly in need and this among other reasons is why Mr. Trump wants Obamacare repealed and replaced with a “universal” health care system that encourages more competition among private health insurers for most of us with an emphasis on reforming how taxpayers pay for our health care safety net.
In the video linked below, Johns Hopkins 2015 Physician Of The Year, Ramin Oskoui confirms that Donald Trump is NOT proposing a “Single Payer Socialized Medicine” plan:
Handling preexisting conditions in the individual health insurance marketplace.
What I found lacking in Mr. Trump’s proposals is specifically how preexisting conditions will be covered in the individual health insurance market place. Some Republicans are proposing a preexisting solution to preexisting conditions. They rely upon protections that existed before the PPACA as outlined in sections 2741 and 2744 of 1996 HIPPA law for those who are HIPAA qualified. This means that they have maintained existing coverage for at least 18 months with no lapse in coverage of more than 63 days. These insured members would have guaranteed access to coverage for preexisting conditions in the individual marketplace via:
A). A state high risk health insurance pool – which existed in 35 states long before PPACA
B.) A guarantee issue individual mandate – which existed in 10 states – including Ohio – long before the PPACA
C.) A state mandated replacement policy – which is required to be offered in the states that did not have one of the two aforementioned options under section 2744 of HIPAA.
That is one option that Mr. Trump could consider. That option would require rebuilding and refunding that preexisting state infrastructure since that was largely abolished because it was no longer necessary upon full implementation of the PPACA in 2014.
This brings me to Mr. Trump’s other option. To keep our existing national 90 day open enrollment period which was originally an idea used by 10 different states long before the PPACA. However, if Mr. Trump chooses this option, he absolutely must correct the mistake made by the ‘masterminds’ who wrote the PPACA. That mistake was not allowing health insurers to underwrite normal paper throughout the year. This was allowed in states like Ohio (and 9 other states) long before the PPACA. In fact, that’s where the ‘authors’ of the PPACA got the idea of a short annual open enrollment period for those with preexisting conditions. The state of Ohio was doing that for all Ohio residents for years before the PPACA. However, Ohio regulators did not stop health insurers from underwriting individual health insurance coverage throughout the rest of the year. So, people with preexisting conditions that were severe enough to warrant a decline (cancer, diabetes, morbid obesity etc.) could purchase health insurance during the annual open enrollment window and everyone else could buy health insurance throughout the rest of the year whenever they wanted. Best part? That system worked remarkably well without the unconstitutional imposition of an ‘individual mandate’ to purchase health insurance.
By allowing health insurers to underwrite other consumers with less severe preexisting conditions like Hypertension or Hyperlipidimia throughout the rest of the year, health insurers were able to mitigate the risk they would have to assume during the annual open enrollment period. The ‘masterminds’ who wrote the PPACA decided that part wasn’t such a good idea to include. You know, because they didn’t want those ‘evil’ insurance companies ‘discriminating’ against anyone. How exactly is that ‘discriminating’ when the carriers were still offering those consumers coverage and covering their preexisting conditions? It’s not, but the masterminds of the PPACA decided to place their Leftist ideology ahead of time tested and proven business models. Surely we can do better.