The healthcare strategy in the Trump Administration’s recent 2020 budget proposal is a huge gift to Democrats. Unfortunately, Democrats don’t appear eager to unwrap it.
The Trump proposal cuts Medicare by $800 billion and Medicaid by $1.5 trillion over the next 10 years. That includes a cut of $100 billion to nursing homes and home health agencies that care for Medicare patients after a hospital stay. in 2020, the National Cancer Institute gets cut by $900 million; other medical research gets cut by $1 billion more. Wow.
Knowing that Trump campaigned in 2016 on a promise not to touch Medicare and Medicaid, his folks are currently on all the talk shows claiming that those budget numbers do indeed increase year-to-year. While that’s technically true from a raw numbers perspective, when a budget doesn’t account for inflation or the growth of the covered population, it’s a cut.
Seemingly surprised when people notice that fact, Trump officials then randomly claim that massive savings will be realized by reducing fraud and waste (which will require more enforcement that will eat up much of the savings), reducing payments to providers (which will reduce the number and quality of providers), moving accountability to the states (which will only pass the buck on budget shortfalls), and/or anything else they can think of that might distract anyone paying even cursory attention.
The budget also endorses renewed efforts to repeal what’s left of the Affordable Care Act, despite the fact that the repeal effort failed back when Republicans controlled both houses of Congress. Trump, however, still wants to blame ObamaCare for everything wrong with the world when, in practice, the ACA is now mostly just a guarantee of coverage for pre-existing conditions. A repeal at this point would only mean that some people couldn’t even get expensive health insurance when 3/4 of the voting population favors requiring insurance companies to cover pre-existing conditions.
[ Here’s a thought experiment: What do you think would happen if Congress put a repeal-and-replace bill on Trump’s desk that was EXACTLY the features of ObamaCare but renamed to TrumpCare? Does anyone believe Trump wouldn’t claim it was a brilliant idea and sign it without hesitation? Yeah. I’m fine with that. Obama would be fine with it, too. ]
The Trump budget is DOA in Congress, but the GOP is now stuck with either defending it or running afoul of Trump & Company. Piss off Trump and put a giant target on your right side. Piss off the AARP and write off the voters who are the most likely to actually vote. Heh.
You’d think that Democrats could ride this to an easy win in 2020. You’d be wrong.
Many Democrats seem enamored with some version of Medicare-For-All – essentially a move to a single-payer system either gradually or immediately. The former is well-intentioned and may someday be a decent idea but, since 2/3 of the country doesn’t yet support it, it’s simply not worth the political capital to push it too hard in 2020. The latter is just a horrible idea all around as it would quickly kill a trillion-dollar U.S. industry with devastating economic impacts. And, oh yeah: a comprehensive Medicare-For-All could cost in the neighborhood of $32 trillion over the next 10 years. Yikes.
And yet, Progressives are quite vocally claiming that anyone on the left who dares to question Medicare-For-All is in bed with the healthcare industry. And, okay, that may well account for some small portion of the opposition. However, some of us would simply prefer to pursue policies that (a) have a chance to become law rather than rally chants and that (b) increase the chances of a Democratic win of the White House in 2020. Most of us don’t impugn progressive motives no matter how ill-informed and naïve we may consider their positions. We’d appreciate the same respect. Thanks. And have a nice day.
From my perspective, there’s plenty of sane, left-of-center ground that I’d love to see some Democratic presidential candidate(s) loudly claim. A 2020 Platform for healthcare might include some of the following ideas:
ACA Protection: Protect what’s left of the ACA. Guarantee reasonably-priced insurance coverage for everyone, including people with pre-existing conditions.
ACA Expansion: Improve and strengthen the ACA. For example, reinstate the mandate that all individuals carry health insurance OR sign a binding agreement to forego ANY government-funded medical assistance. Such an agreement would be clearly noted on all drivers licenses and other government-issued IDs. This isn’t just about giving insurance companies a broad customer pool in order to reduce their coverage costs – although that’s a great side benefit. Frankly, I don’t want to pay for anyone’s emergency medical care just because they decided they didn’t want to pay for health insurance. Someone doesn’t like the individual mandate? Call their bluff. See if they’ll state a willingness to die if they’re in car wreck without health insurance or the ability to pay up-front. If so, cool. Their call.
Medicare Protection: Medicare is a contract our country currently has with over 60 million Americans. We also have a ton of baby-boomers who are quickly approaching eligibility and the contract must apply to them as well. Healthcare for seniors must to be sacrosanct. It’s good policy; it’s good politics; it’s the right thing to do. Win; Win; Win.
Medicare Improvement: Allow Medicare to negotiate prescription drug costs. It’s insane that this isn’t already allowed. The Empowering Medicare Seniors to Negotiate Drug Prices Act of 2019 is currently making its way through Congress. Despite opposition from the pharmaceutical industry, this bipartisan bill needs to pass. Now.
Medicare Expansion: Allow people between the ages of 55 and 64 to optionally buy into Medicare at some reasonable cost. The program is already there, it works, and it could use the cash influx from a healthier population than it currently serves. It also removes a portion of the older population from the ACA marketplace thus helping to keep costs under control there as well.
Prepare for the Future: Recognize that some version of a single-payer system might be a valid long-term goal. Do the research. Hold hearings. Determine how to pay for it. Get buy-in from the major players. Convince the public. And THEN introduce legislation.
Improve Healthcare: Recognize the difference between healthcare and health insurance. Most of the above is a discussion of health insurance – despite the fact that we all call it healthcare. The interesting part of the semantic distinction is that government could have immediate impact enabling true healthCARE reform. Screwing with just the insurance market is like focusing on optimizing a 911 service but forgetting that someone has to respond to the call. Here’s just a few arenas where the government could help improve healthcare through education, regulations, and/or tax incentives:
- Require healthcare providers to empower patients with more information. Data is good. It’s better all around to have fully informed patients who are heavily involved in the purpose and cost-effectiveness of their own care. This includes readable care plans, cost transparency, bill simplification, and an easy means of evaluating alternatives. For example, the cost of a simple colonoscopy can vary by 600% from one location to another. There’s no reason why value shopping can’t apply to healthcare if consumers have easy access to the information. Consider an Amazon for healthcare.
- Encourage the creation and usage of low-cost healthcare alternatives. Competition is good. Mergers are currently rampant in the healthcare industry and many doctors are choosing to associate with hospitals rather than remain in private practice. When there’s only one store in town, there’s only one price. While there’s definitely a role for the personal physician who knows the patient and can customize care when needed, there’s also a role for a doc-in-a-box that can simply prescribe a Z-Pack for a minor infection. Even within a doctor’s office, task shifting from doctors to nurse practitioners can dramatically reduce costs for some care needs. Consider a Southwest Airlines for healthcare.
- Encourage portable, consumer-owned health records enabling consumers to manage their own healthcare rather than simply outsource it to physicians. Require providers to share all care data with consumers in common formats so that they can, in turn, share it with other providers as they see fit.
- Encourage technology-based healthcare solutions ranging from digital therapeutics to e-health. Technology can reduce costs while improving care. Regulatory barriers need to fall; tax incentives should be considered.
- Promote competition in the pharmaceutical industry. Reduce barriers for the development of generic and biosimilar products and expedite their approval.
- Increase funding of medical research. There are major national health issues that require funding beyond what the market can reasonably afford. In the long term, a healthier populace is the best way to reduce healthcare expenditures. Cancer, Alzheimer’s, and HIV come to mind as deserving of government attention. Of course, such funding needs to come with conditions that prevent pharmaceutical companies from claiming excessive profits when the underlying research is publicly funded.
My healthcare bottom lines for 2020 Democrats: Be compassionate. Be creative. Don’t be stupid.