The fact that Donald Trump doesn’t know anything about healthcare policy wouldn’t matter much were he to have remained a reality television star, but now that he’s the front-runner for the Republican nomination, it could be dangerous to your health.
With Obamacare struggling to meet enrollment targets, insurers racking up losses from participating in the program, and premiums spiking, there will be an opening for the next president to make changes to the healthcare system. The question is, will those changes impose more government control to the system, or inject more freedom? Anybody hoping for the latter shouldn’t be very comfortable with Trump.
To start, though Trump says most of the time that he opposes most of Obamacare, he has at various times endorsed a government-run system. When confronted by Sen. Ted Cruz about this in Thursday night’s debate, Trump directly contradicted his past statements. Or to put it more simply: Trump blatantly lied.
Cruz asked Trump a direct question: “Donald, true or false, you’ve said the government should pay for everyone’s healthcare?” Trump responded: “That’s false.”
Yet last September, Trump told CBS’ “60 Minutes” that, “Everybody’s got to be covered” and that “the government’s gonna pay for it.”
Sen. Marco Rubio pointed out something else – that Trump claimed just last week that he liked Obamacare’s individual mandate. Trump reversed his position within 24 hours.
In the debate, Trump responded, “except pre-existing conditions, I would absolutely get rid of Obamacare.” Let’s assume that when he said, “I want to keep pre-existing conditions” he meant he wants to keep the ban on insurance companies denying health insurance to individuals based on pre-existing conditions, not that he wants to bring them back.
But the problem is that once insurers are forced to cover all comers, those who are currently healthy have no reason to purchase insurance until after they get sick. That means that those seeking insurance are a lot sicker, which drives up premiums, thus discouraging yet more healthy people from purchasing insurance. This leads to a “death spiral” in which private insurance becomes unsustainable. This is why a number of states that banned pre-existing conditions in the 1990s, such as Kentucky, saw their health insurance markets eviscerated, as insurers stopped doing business in the state because they couldn’t make a profit.
This is the idea behind the mandate, which aims to coerce younger and healthier individuals into purchasing insurance to offset the cost of insuring older and sicker individuals.
Trump insisted that he would cover those with pre-existing conditions but would produce “something much better” than Obamacare. He was reluctant to provide details, but he did argue, “We should have gotten rid of the lines around each state so we can have real competition. We thought that was gone, we thought those lines were going to be gone, so something happened at the last moment where Obamacare got approved, and all of that was thrown out the window.”
The best guess as to what Trump was arguing was that he wants to remove the barriers preventing insurers from offering coverage across state lines, which is one aspect of market-based health proposals. But there are a few problems with Trump’s version of this argument.
To start, Congress was never close to removing restrictions on interstate purchase of insurance, and certainly not within the context of the Obamacare debate. So that was just made up out of whole cloth.
But beyond that, it’s important to realize that the reason why free market advocates believe in allowing interstate competition is to get around the costly regulations that, even before Obamacare, existed at the state level. Yet the most costly regulation of all was the ban on pre-existing conditions along with the limits on what insurers could charge sicker individuals. For Trump to impose such regulation at the federal level would negate the whole rationale for allowing the interstate purchase of insurance.
Trump also said that getting rid of the state lines would prevent situations in which a state had only one insurer. But we do have an example of a state that only had one insurer in the pre-Obamacare world. And that was Maine – which happened to be a state that imposed a pre-existing condition requirement on insurers in 1993 in the absence of an individual mandate – the policy Trump is advocating for the whole country.
If Republicans are going to stop the momentum toward greater federal control of the healthcare system, they are going to have to present an alternative to the Democratic vision of more government and win the debate. But that would be impossible with Trump as the nominee, because any Democrat would easily expose Trump’s ignorance and serial dishonesty on the issue.
