“Trade, we are going to fix it; health care, we are going to fix it; women’s health issues, we are going to fix it,” Trump said.

Mobile, Alabama August 21, 2015

I was in of of the 30,000 (well, more like 15,000) people in stands at Ladd-Peebles stadium when Donald Trump announced his health care position. My late wife Danielle Juzan live-tweeted the rally as well.Whatever was wrong, he said, he would fix it.

My friend Josh Freeman just posted a blog where he cites the JAMA article written by President Obama to detail the successes and failures of the Affordable Care Act (now in year 6 of being enacted and year 4 of implementation). Bottom line, in those states that have expanded Medicaid, poor much better off. In all states, health insurance for those working still too expensive. In all states, quality of care is beginning to improve. It is widely assumed that a Clinton/Kaine administration will work to strengthen the gains made through Obamacare.

Trump declined to explain how he would lower insurance costs (other than saying “more competition”), but he did specify how he would deal with those who lack insurance. He said that the government would negotiate with hospitals to cover the uninsured.

60 minutes, September 27, 2015

In the evolution of Donald Trump’s health care policy, he has transitioned from universal coverage. As a business man with interests in many countries, he has seen the impact of more healthcare delivery in countries such as Scotland and has admired the ease and efficiency of care. In one of the debates, in fact, he expressed his admiration for other country’s care delivery.  “As far as single payer, it works in Canada. It works incredibly well in Scotland.”

“We will repeal and replace disastrous Obamacare,” Trump said. “You will be able to choose your own doctor again.”

Donald J Trump’s acceptance speech, Republican National Convention

Upon wrapping up the nomination, the Trump campaign fleshed out his healthcare position (found here). Aside from “repeal and replace with something terrific” the plan is a little light on specifics. However, as this is a presidential candidate and we have to assume he has a shot at being elected, I feel compelled to analyze his stated position on how almost 20% of the GDP will be managed and 25% of our tax dollars will be spent. The key points are as follows:

  • Want universal coverage? The Trump position is to eliminate the mandate BUT keep the pre-existing condition coverage. Policy analysts are a little confused about how this would impact the care delivery system.
  • Like a bare bones policy? Trump proposes eliminated limits on intrastate policy sales. So your company might buy your insurance but there may be no local care delivery options, so you might have to drive to Delaware for care.Now THAT would be bare bones.
  • Allow deductions of premiums from income taxes and use of a healthcare savings account. A nice position to take if you want the vote of young, healthy people. As most chronically ill people make very little money and spend a lot on healthcare, this does not benefit those who are sick.
  • Require price transparency. Now this one, I can get behind. Check out health care blue book, kinda coming anyway.
  • Block grant Medicaid. Theory is “States know how to use the money best.” Bill Clinton did this with “welfare” (actually cash payments known as TANF) in the 1990s. The outcome? Total money available was reduced and less money was spent on child care (increasing the penalty to working parents who needed assistance). In fact, half of the money the federal government sent for TANF-like programs went for things like middle class tuition reimbursement.
  • Allow people to negotiate with foreign drug companies. This started out as “Medicare ought to negotiate for lower drug prices” but has ended up “feel free to mail order drugs from Canada.” Kinda odd how our negotiator-in-chief let that happen.

Should make for an interesting debate.