Trump's long-awaited healthcare "plan" is a joke

He can barely bring himself to pretend he cares.

Paul Waldman

“In two weeks” finally arrived.

That’s the usual time period in which Donald 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.

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.

Why the GOP Healthcare Plans Won’t Fill the Prescription

So is this the best they can do?

Dean Baker in Beat the Press

During his first term, after repeatedly promising the country a terrific healthcare plan, Donald Trump famously commented, “Nobody knew that healthcare could be so complicated.” In fact, everyone who spent even a few minutes looking at the issue knew that healthcare was complicated. 

That is why Obamacare ended up being a hodgepodge that was pasted together to extend healthcare coverage as widely as possible. It is also the reason Trump and the Republicans never produced a healthcare plan in Trump’s first term.

The basic problem is that healthcare costs are hugely skewed. Ten percent of the population accounts for more than 60% of total spending, and just 1% accounts for 20% of spending. Most people have relatively low healthcare costs. The trick with healthcare is paying for small number of people who do have high costs.

Individual Choice, Cherry-Picking the Pool, and Screwing Cancer Survivors

The Republicans in Congress, along with Trump on alternate days, are pushing plans that are supposed to give choice to individuals and somehow take it away from insurers. It’s not clear what they think they are saying. They seem to still envision that people will buy insurance, as they do now in the Obamacare exchanges, but somehow that they will have more control in the Republican option.

There is one story they could envision, which would make it much easier for insurers to skew their pool. The Affordable Care Act (ACA) restricted what sort of plans could be offered in the exchanges in order to limit the ability for insurers to avoid high-cost individuals.

It would be possible to relax these restrictions to allow insurers to cherry pick their enrollees. For example, they could offer high-deductible plans, say $15,000 in payments, before any coverage kicked in.

No person with a serious health condition would buy this sort of plan since they know they would be paying at least $15,000 a year in medical expenses, and then a substantial fraction of everything above this amount, in addition to the premium itself. 

On the other hand, a low-cost plan with $15,000 deductible might look pretty good to someone in good health, whose medical expenses usually don’t run beyond the cost of annual checkup.

Trump unveils his Trumpcare plan

 

What? Not Job Lot?

The Trump Coalition Wants to End Democracy as We Know It

Breakdown of four groups who want a few billionaires and certain religious zealots to consolidate their political power.

Peter Montague for Common Dreams

The Trump coalition includes four groups of people:

1. The MAGA (“make America great again”) base, mostly rural white men and women;
2. A group of Silicon Valley billionaires known as the PayPal Mafia;
3. A separate political movement called “religious nationalists”; and
4. The Trump crime family itself.

All four groups share one basic aim: to degrade our one-person-one-vote election system so a few billionaires and certain religious zealots can consolidate their political power to eliminate free and fair elections to become even more controlling and richer than they already are.

Here are brief descriptions of the four groups.

1: The MAGA Base: Who Are They?

The hardcore, mostly rural MAGA base can be understood as an echo of the Confederacy. Philosophically, many of them are the same people who tried to destroy the United States to preserve slavery via the Civil War (1861-1865). In their view, the basic ideas that inspired the founding of the U.S. (1776-1788) are wrong: All humans are not created equal and should not have equal rights under law. In 2022, MAGA believers included about 15% of the U.S. adult population, or about 39 million out of 258 million adults.

DISCLOSURE: Peter is a valued old friend. We collaborated often when I was organizing director at the organization now known as the Center for Health and Environmental Justice especially on issues that involving fighting corporate crime.

Measles Is Back: Doctors Warn of Dangerous Surge Across the U.S.

Under Trump and RFK Jr., measles is back bigly

By Ann & Robert H. Lurie Children's Hospital of Chicago

Pediatric experts are calling for renewed focus on measles vaccination as outbreaks reappear in the U.S. Despite having been declared non-endemic, measles poses serious risks, especially to young children, with complications like pneumonia, encephalitis, and even fatal brain disorders such as SSPE. In 2024, 40% of U.S. measles cases required hospitalization. Experts stress that the MMR vaccine is safe and the most effective protection against this highly contagious disease.

Parents are encouraged to contact their pediatrician if their child has been exposed to measles or is showing symptoms.

Pediatric infectious disease experts are emphasizing the critical importance of measles vaccination, as the highly contagious virus is once again spreading across the United States. In an article published in Pediatrics, they provide updated guidance for pediatricians on how to recognize, prevent, and manage this vaccine-preventable disease.

Measles, caused by the measles virus, is one of the most contagious infectious diseases known, capable of spreading to 90% of unvaccinated individuals exposed to an infected person. It is transmitted through respiratory droplets and can remain airborne for up to two hours after an infected person has left the area.

“The most effective way to prevent measles is vaccination,” said lead author Caitlin Naureckas Li, MD MHQS, infectious diseases specialist at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. 

Trump’s Return Puts Medicaid on the Chopping Block

Gotta get the money for billionaire tax cuts from somewhere, right?

Phil Galewitz, KFF Health News 

Under President Joe Biden, enrollment in Medicaid hit a record high and the uninsured rate reached a record low.

Donald Trump’s return to the White House — along with a GOP-controlled Senate and House of Representatives — is expected to change that.

Republicans in Washington say they plan to use funding cuts and regulatory changes to dramatically shrink Medicaid, the nearly $900-billion-a-year government health insurance program that, along with the related Children’s Health Insurance Program, serves about 79 million mostly low-income or disabled Americans.

The proposals include rolling back the Affordable Care Act’s expansion of Medicaid, which over the last 11 years added about 20 million low-income adults to its rolls. Trump has said he wants to drastically cut government spending, which may be necessary for Republicans to extend 2017 tax cuts that expire at the end of this year.

Trump made little mention of Medicaid during the 2024 campaign. The first Trump administration approved work requirements in several states, though only Arkansas implemented theirs before a federal judge said it violated the law. The first Trump administration also sought to block grant funding to states.

House Budget Committee Chair Jodey Arrington (R-Texas) told KFF Health News that Medicaid and other federal entitlement programs need major changes to help cut the federal debt. “Without them, we will watch this country sadly enter into fiscal collapse.”

The Second Trump White House Could Drastically Reshape Infectious Disease Research.

Here’s What’s at Stake.

by Anna Maria Barry-Jester for ProPublica

Lifesaving HIV treatments. Cures for hepatitis C. New tuberculosis regimens and a vaccine for RSV.

These and other major medical breakthroughs exist in large part thanks to a major division of the National Institutes of Health, the largest funder of biomedical research on the planet.

For decades, researchers with funding from the NIH’s National Institute of Allergy and Infectious Diseases have labored quietly in red and blue states across the country, conducting experiments, developing treatments and running clinical trials. With its $6.5 billion budget, NIAID has played a vital role in discoveries that have kept the nation at the forefront of infectious disease research and saved millions of lives.

Then came the COVID-19 pandemic.

NIAID helped lead the federal response, and its director, Dr. Anthony Fauci, drew fire amid school closures nationwide and recommendations to wear face masks. Lawmakers were outraged to learn that the agency had funded an institute in China that had engaged in controversial research bioengineering viruses, and questioned whether there was sufficient oversight. Republicans in Congress have led numerous hearings and investigations into NIAID’s work, flattened NIH’s budget and proposed a total overhaul of the agency.

More recently, Robert F. Kennedy Jr., Trump’s nominee to run the Department of Health and Human Services, which oversees the NIH, has said he wants to fire and replace 600 of the agency’s 20,000 employees and shift research away from infectious diseases and vaccines, which are at the core of NIAID’s mission to understand, treat and prevent infectious, immunologic and allergic diseases. He has said that half of NIH’s budget should focus on “preventive, alternative and holistic approaches to health.” He has a particular interest in improving diets.

Even the most staunch defenders of NIH agree the agency could benefit from reforms. Some would like to see fewer institutes, while others believe there should be term limits for directors. There are important debates over whether to fund and how to oversee controversial research methods, and concerns about the way the agency has handledtransparency. Scientists inside and outside of the institute agree that work needs to be done to restore public trust in the agency.

But experts and patient advocates worry that an overhaul or dismantling of NIAID without a clear understanding of the critical work performed there could imperil not only the development of future lifesaving treatments but also the nation’s place at the helm of biomedical innovation.

Deja Vu

Concept of a plan

Making America Underinsured Again

Expect another big push for substandard health insurance

By Philip Mattera, director of the Corporate Research Project in the Dirt Diggers Digest

Health insurance policy was not a major topic during a presidential campaign dominated by talk of immigration, inflation, reproductive rights, and threats to democracy. The issue’s main appearance was during the September debate, when Trump made his much-ridiculed remark about having “concepts of a plan” to replace the Affordable Care Act.

Now it turns out that Republicans have chosen healthcare as one of their priority issues as they prepare to assume full control of Congress. The Washington Post reports that GOP lawmakers and Trump advisers are discussing significant cuts in Medicaid—both the traditional part of the program designed to provide coverage for those in poverty as well as the expansion to middle income families that made up part of Obamacare.

This would serve several purposes. First, the purported savings would make it easier to gain support for an extension of the 2017 tax cuts scheduled to expire at the end of next year. Extending the giant giveaways to corporations and the wealthy would add an estimated $4 trillion to the national debt. Offsetting some of that with Medicaid reductions would allow Republicans to depict themselves as fiscally responsible.

It would also fit into the campaign being spearheaded by Elon Musk to give the impression that the new administration is going to do something about government waste.

There is no indication, however, that either Musk or Congressional Republicans intend to target the real culprits behind any wasteful spending in the Medicaid system: improper and fraudulent billing by healthcare providers and the inflated prices of prescription drugs.

Instead, the crusade against Medicaid will apparently focus on the phony issue of work requirements. This is the same scheme used by conservatives for decades to undermine safety net programs: make exaggerated claims about abuse and use this to justify complicated new eligibility rules that are designed to eject large numbers of beneficiaries. 

Inflation pushed many voters toward Trump

His policies might drive prices higher again

Veronika Dolar, Pace University

President-elect Donald Trump owes his political comeback in large part to voters’ concerns over the soaring price of everything from gasoline and housing to coffee and bagels.

Inflation has since come down to levels close to normal thanks in large part to a steep rise in interest rates. But in an ironic twist, some of Trump’s own policies – which he heavily promoted on the campaign trail – could send inflation soaring once more if enacted. 

Specifically, economists caution that his proposed policies on tariffs, immigration and taxes may do more to exacerbate inflation than curb it.

In my introductory economics classes, I teach my students about the unintended consequences of policies and how they can sometimes be counterintuitive. Common-sense economics often falls short, and this is evident in several policies proposed by Trump, where the expected outcomes may not align with their actual impacts.

Stagnant real wages

Exit poll data reveals that Americans felt the sting of rising prices in recent years, as inflation-adjusted wages strained household budgets.

Even as the Federal Reserve has managed to bring inflation much closer to its 2% target, many Americans continue to describe prices as “too high,” an echo of the past several years’ cost increases that persistently outpaced wage growth.

When inflation outpaces wage growth, the purchasing power of each dollar erodes, leaving workers struggling to afford the same goods and services. This erosion has been felt particularly hard in recent years, but it’s part of a long-term trend of sluggish wages.

Inflation-adjusted wages have been largely stagnant for decades, with certain metrics revealing a dismal reality. For example, the federal minimum wage, created in 1938 and set at US$7.25 since 2009, is now worth less than half of what it was over 50 years ago. Back in the late-1960s, the minimum wage was worth the equivalent of $14.50 per hour in today’s money after adjusting for inflation.

Vance Rewrites History About Trump and Obamacare

They lie and don't care if they get caught

Julie Appleby, KFF Health News 

Donald Trump could have destroyed the Affordable Care Act, but “he chose to build upon [it].”

Sen. JD Vance (R-Ohio) on “Meet the Press,” Sept. 15

Sen. JD Vance (R-Ohio) on Sept. 15 told viewers of NBC’s “Meet the Press” that former President Donald Trump built up the Affordable Care Act, even though Trump could have chosen to do the opposite.

“Donald Trump had two choices,” Vance, Trump’s running mate, said. “He could have destroyed the program, or he could actually build upon it and make it better so that Americans didn’t lose a lot of health care. He chose to build upon a plan, even though it came from his Democratic predecessor.”

The remarks follow statements the former president made during his Sept. 10 debate with Vice President Kamala Harris in Philadelphia. Trump said of the ACA, “I saved it.”

The Affordable Care Act, aka Obamacare, has grown more popular as Americans have increasingly used it to gain health coverage. More than 20 million people enrolled this year in plans sold through the marketplaces it created. That makes the law a tricky political issue for Republicans, who have largely retreated from their attempts over the past decade to repeal it.

Both Vance’s and Trump’s statements are false. We contacted Vance’s campaign; it provided no additional information. But here’s a review of policies related to Obamacare that Trump pursued as president.

Such a big heart

By Matt Davies

Voters most concerned about health costs

 Voters Want to Hear From Biden and Republicans

Julie Appleby, KFF Health News and Phil Galewitz, KFF Health News 

Jeff Danziger

President Joe Biden is counting on outrage over abortion restrictions to help drive turnout for his reelection. Former President Donald Trump is promising to take another swing at repealing Obamacare.

But around America’s kitchen tables, those are hardly the only health topics voters want to hear about in the 2024 campaigns. 

A new KFF tracking poll shows that health care tops the list of basic expenses Americans worry about — more than gas, food, and rent. Nearly 3 in 4 adults — and majorities of both parties — say they’re concerned about paying for unexpected medical bills and other health costs.

“Absolutely health care is something on my mind,” Rob Werner, 64, of Concord, New Hampshire, said in an interview at a local coffee shop in January. He’s a Biden supporter and said he wants to make sure the Affordable Care Act, also known as Obamacare, is retained and that there’s more of an effort to control health care costs.

The presidential election is likely to turn on the simple question of whether Americans want Trump back in the White House. (Nikki Haley, the former South Carolina governor and U.S. ambassador to the United Nations, remained in the race for the Republican nomination ahead of Super Tuesday, though she had lost the first four primary contests.) And neither major party is basing their campaigns on health care promises.

But in the KFF poll, 80% of adults said they think it’s “very important” to hear presidential candidates talk about what they’d do to address health care costs — a subject congressional and state-level candidates can also expect to address.

“People are most concerned about out-of-pocket expenses for health care, and rightly so,” said Andrea Ducas, vice president of health policy at the Center for American Progress, a Washington, D.C.-based progressive think tank.

Here’s a look at the major health care issues that could help determine who wins in November.

What Would a Second Trump Presidency Look Like for Health Care?

In his first term, his COVID policies killed almost a million Americans. Can he top that?

Julie Rovner, KFF Health News 

Trump might appoint someone like this to head
 Health and Human Services

On the presidential campaign trail, former President Donald Trump is, once again, promising to repeal and replace the Affordable Care Act — a nebulous goal that became one of his administration’s splashiest policy failures.

“We’re going to fight for much better health care than Obamacare. Obamacare is a catastrophe,” Trump said at a campaign stop in Iowa on Jan. 6.

The perplexing revival of one of Trump’s most politically damaging crusades comes at a time when the Obama-era health law is even more popular and widely used than it was in 2017, when Trump and congressional Republicans proved unable to pass their own plan to replace it. That failed effort was a big part of why Republicans lost control of the House of Representatives in the 2018 midterms.

Despite repeated promises, Trump never presented his own Obamacare replacement. And much of what Trump’s administration actually accomplished in health care has been reversed by the Biden administration.

Still, Trump secured some significant policy changes that remain in place today, including efforts to bring more transparency to prices charged by hospitals and paid by health insurers.

Trying to predict Trump’s priorities in a second term is even more difficult given that he frequently changes his positions on issues, sometimes multiple times.

The Trump campaign did not respond to a request for comment.

Perhaps Trump’s biggest achievement is something he rarely talks about on the campaign trail. His administration’s “Operation Warp Speed” managed to create, test, and bring to market a covid-19 vaccine in less than a year, far faster than even the most optimistic predictions.

Many of Trump’s supporters, though, don’t support — and some even vehemently oppose — covid vaccines.

Here is a recap of Trump’s health care record:

Why Trump loves the poorly educated

TrumpCare: it'll be unbelievable!

Why Is America So Vulnerable to Charlatans Like Trump?

He's a con man, liar, hate-mongerer whose lies have cost at least half a million American lives. Yet his MAGAnuts love him.

THOM HARTMANN

Donald Trump is a confidence man, a charlatan, an unrepentant liar whose deceits have cost at least a half-million Americans their lives.

When Dustin Thompson was hauled before US District Judge Reggie Walton for assaulting the Capitol police on January 6th, his defense lawyer, Samuel Shamansky, argued about Trump:

“You had, frankly, a gangster who was in power. The vulnerable are seduced by the strong. That’s what happened.”

The jury didn’t buy the argument and sent Thompson to prison, as US District Judge Reggie Walton, who was overseeing the case, said:

“I think our democracy is in trouble because, unfortunately, we have charlatans like our former president who doesn’t, in my view, really care about democracy but only about power.”

And yet Trump remains popular with about 20 percent of the American public, making up the majority of the Republican primary-voting base. But why?

There’s nothing new about charlatans and confidence men. Marco Antonio Bragadini (1545-1591) was one of Europe’s most famous: he convinced both a pope and the government of Venice that he could turn lead into gold and they financed a lavish lifestyle for most of his life.

William Thompson was America’s first labeled “confidence man” in New York in the 1840s because he’d approach wealthy men, pretend they were old friends, and ask them if they had “the confidence” to give him their gold watch for an hour: many did, and he ran the scam for years before being busted.

Donald Trump similarly convinced banks that he was had assets worth ten, twenty, sometimes more than fifty times their real value as was revealed in court this week. The self-proclaimed “king of debt” then used his borrowed money to support a lifestyle that reinforced everybody’s belief that he was truly rich.

After American banks refused to lend Trump money, he and his good friend Jeffrey Epstein turned to Deutsche Bank and managed to extract over $2 billion from that institution with the help of William Broeksmit, Thomas Bowers, and Justin Kennedy.

Loser

By Matt Wuerker