Trump’s views on health care are inchoate, derivative, and largely irrelevant. While he has occasionally
praised the benefits of single-payer plans in the past (going so far as to laud the Canadian system and the Scottish NHS), he now
largely serves up typical conservative talking points.
The danger, therefore, is not in some unique Trumpian health care vision, but in the successful enactment of the GOP’s health care agenda: repealing major provisions of the Affordable Care Act (ACA) and/or replacing it with an ostensibly more market-driven system.
As Sarah Kliff
writes at
Vox, Republicans already passed a bill (vetoed by Obama) that would have repealed the major insurance coverage provisions in the ACA, which could potentially strip some
22 million people of health insurance.
This would be tantamount to a humanitarian disaster: suddenly wresting insurance from this many people could kill upwards of twenty thousand people a year (methods for this rough calculation are
here). And of course, such carnage would disproportionately affect the usual victims: the working class and racial minorities.
Whether Republicans would actually seek to pass such a bloodthirsty law, however, is unclear, and there are many reasons to be skeptical (it could be very politically damaging and adversely affect key health care industry players, to name just two).
But at the very least, it seems probable that Republicans will attempt to roll back the ACA’s coverage expansion in some way, while at the same time “reforming” the system along conservative, market-based lines. For a taste of what they will likely pursue, unimpeded by Obama’s veto, we can turn to the
health care blueprint of Paul Ryan and the House Republicans.
Released in June, the thirty-seven-page document outlines a package of policy proposals — much of it based on long-established health care policy ideas — that would advance so-called “consumer-driven healthcare” (e.g. health-savings accounts), partially shred the health safety net, privatize Medicare, and increase profits for Big Pharma at the expense of public health.
Some of these ideas have bipartisan roots. For instance, Ryan and company want to limit the tax exclusion for employer-provided health insurance plans — a more drastic version of the ACA’s “Cadillac Tax,” which penalizes workers with more comprehensive health plans. In addition, the Republicans wish to promote and expand “workplace wellness” —
occasionally Orwellian programs that the ACA also favored.
At the same time, Ryan calls for weakening the ACA’s protections for those with pre-existing conditions (he’d only protect those who maintain continuous coverage), and undermining Medicaid coverage by reducing and restructuring federal funding and giving greater control to the states.
Perhaps most destructively, the GOP blueprint effectively advocates ending Medicare, by “transforming the benefit into a fully competitive market-based model” that it calls “premium support.”