Trump imagines the federal government in the role of master dealmaker in the health-care market. In reality, but the main problem is lack of competition.
Donald Trump doesn’t know what he thinks about health care. He has been a periodic advocate of a United Kingdom–style monopoly system and a periodic critic of such monopolies. He says that we should repeal the so-called Affordable Care Act and replace it with . . . something. Something “terrific.”
When asked by New Hampshire debate moderator Mary Katharine Ham whether his flirtations with single-payer leave him closer to Vermont socialist Bernie Sanders than to mainstream Republicans, Trump gave a hilariously incoherent answer based in one part on banalities and one part on lies — which is the Trump magic formula.
He said that he was the only candidate on stage free to explore all the policy options because he is self-funded and therefore not beholden to special interests.
Trump is in fact mainly funded by donors, like the other candidates, but he persists in this lie, brazenly.
He also claimed that the insurance companies are “getting rich on Obamacare,” which would be news to United, Cigna, Aetna, and others who have taken a bath on their ACA offerings. (They might have thought they were going to get rich — it’s nice to have a federal law mandating the purchase of your product — but, having gone to bed with the devil, they are waking up with a burning sensation.)
Trump also promises a system that would not leave Americans “dying on the street.”
Trump likes to talk about “deals,” and to tout his purported expertise as a dealmaker. To the extent that he has communicated anything that deserves to be called an idea on the issue of health care, it is in joining in with Barack Obama, Bernie Sanders, Hillary Rodham Clinton, et al., in calling for government negotiation with pharmaceutical companies over prescription-drug prices. Trump promises to apply the business acumen he has brought to the casino racket and his reality-television enterprise to negotiate better deals on pharmaceuticals.
It is a superficially appealing position: About two-thirds of Republicans tell pollsters they believe the government should engage in such negotiations. As things stand, the Department of Health and Human Services is prohibited from engaging in direct price negotiations with pharmaceutical companies, a rule that was adopted in the creation of Medicare Part D, the competitive prescription-drug benefit program. There were three reasons for that:
One, it was a sop to the pharmaceutical companies; two, Congress and the George W. Bush administration had quite reasonable concerns that transferring the price-negotiating function from private insurers to the Centers for Medicare and Medicaid Services would create something like a price-fixing monopsony; three, the experience of Medicaid suggests that such negotiations might backfire, with pharmaceutical companies raising their prices in the private market to create the illusion of steeper discounts for government buyers.
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