EDITORIAL
How to Make a Failing Healthcare System Worse

Oct 16, 2017

Having failed in his attempts to get Congress to “repeal and replace” the Affordable Care Act (ACA), Donald Trump issued executive orders he said would completely overhaul it. He declared: “This is something that millions and millions of Americans will be signing up for. They’ll be very happy, and they’ll get great care.”

Happy? Not hardly–not unless they wanted insurance that provides little coverage! Great care? Not a bit of it!

Under the ACA, someone can have short-term coverage for three months, while they wait for other coverage. Those short-term plans were not subjected to ACA’s requirements that insurance must cover a list of essential health benefits and put a cap on out-of-pocket medical expenses. Trump’s order seems to extend the limit on short-term plans from three months to one year. Effectively, that could mean that insurance companies may ignore these requirements indefinitely, since insurers sell their plans on a yearly basis.

Trump also said he was going to cut off some subsidies the federal government makes to insurance companies that provide health plans on the individual ACA marketplace. The reduction of those subsidies gives insurance companies an excuse to raise premiums. In fact, many already have, citing “unpredictability” in the marketplace. And many states have already approved large increases. In other words, they didn’t need Trump’s executive orders to do so.

In fact, what those executive orders will do is not at all clear. The regulations haven’t been written. Not one detail, not one rule. No one knows who will write them. No one has any idea what will come of it. It’s typical Trump braggadocio, bragging that he has done something, when all he did was open his mouth.

Trump referred to the ACA subsidies as gifts to the insurance companies. He’s right, of course. But we can be sure that no matter how many executive orders Trump issues, he will not harm the insurance companies.

The reality is that medical coverage in this country is aimed first of all at providing profit to the insurance industry, the banks behind them and other medical care industries. The Affordable Care Act, in fact, was written by them. Whatever rules come out of Trump’s executive orders will be written by them.

It’s entirely possible that Trump and the Republicans and Democrats in Congress are simply “playing politics,” each trying to force the other to accept blame for “Obamacare” or whatever they settle on to “replace” it.

But whatever is going to happen, this much is clear: Trump, who has not been able to get a single significant piece of legislation through Congress, is using his latest pronouncement to make it look like he is running things.

Today, after the implementation of the ACA, 28 million Americans remain uninsured and many others are forced to buy expensive healthcare plans that require them to pay a great deal out-of-pocket.

To actually deal with the problem of people not getting the medical care they need, Congress and Trump would first of all have to be ready to take on the insurance companies. They would have to slash profits going to the pharmaceutical and medical supply companies. They would have to make hospital systems non-profit and publicly owned and adequately funded.

If Congress did that, the U.S. might be able to get rid of one of its “honors”–that is, as the country that spends more per person on healthcare than any other industrialized country but has worse health outcomes than any other.

To wait for Congress to do that, however, would be like waiting for them to sprout wings and grow halos. Who would be so foolish?