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“In two weeks” finally arrived.
That’s the usual time period in which President Trump has, for the last 10 years, promised the arrival of a spectacular plan to reform the healthcare system, one that would solve every problem anyone could identify, whether individual or systemic. Just you wait, he’d say — the plan is coming in two weeks, and you’re gonna love it.
Well now the White House has indeed released what it calls “The Great Healthcare Plan.” Is it great? No. Is it a plan? Not really. It is, however, in its combination of stupidity, ideological derangement, and unseriousness, a near-perfect expression of everything Trump and his party believe about a policy challenge that has bedeviled the United States for decades.
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If the White House wanted to enact some kind of healthcare reform, it would put out a document explaining a series of changes it would like to make to the system, then work with Republicans on Capitol Hill to turn those ideas into legislation. That is not happening. There are a few Republican bills rolling around Congress, but no one takes them seriously.
What we have, then, is a bunch of vague statements of principle, some outright nonsense, and a few absolutely terrible ideas.
The very bad healthcare non-plan
The plan (forgive us for using that word) is spread out over a few short documents (here, here, and here). It does contain a few things that look like big ideas, but are immediately baffling.
The biggest is this one: “The government is going to pay the money directly to you,” the plan quotes Trump saying. “It goes to you, and then you take the money and buy your own healthcare.” How exactly is that going to work? We’ll each get a check every month from the government? Is the entire insurance system going to be replaced by health savings accounts?
Worry not: Trump insists that prices will come down, because he says you’ll “go out and buy your own healthcare, and you’ll make a great deal.”
Imagine the future that could be yours. You wake up in the middle of the night with a crushing chest pain. Convinced you’re having a heart attack, your first instinct is to call 911. But wait, you think — I’m an empowered consumer in the free-wheeling healthcare market. As sweat pours down your brow and you struggle for breath, you begin to shop around to decide where you should seek care.
What’s the cost of a triple bypass at St. Joseph’s Hospital? Can I make a deal with them? You check the Yelp reviews on Downtown General to see how many five-star customer satisfaction scores that hospital gets. Then you begin feeling dizzy, and as you slip into unconsciousness, you know that healthcare has finally become great.
This is the ultimate expression of a foundational Republican belief about healthcare, which is that if we could only inject more free-market magic into the system, all the problems that bedevil it would disappear.
We’ll get more into that in a moment, but what else does the Trump plan suggest?