Disgraceful GOP debate exposes Trump’s health-care plan as gibberish

REUTERS/Mike Stone
Sen. Marco Rubio and Donald Trump reacting to each during Thursday night's debate in Houston.

Just a few reactions to the Republican debate Thursday night in Houston, and then a long chunk of transcript that will highlight the elegant simplicity of Donald Trump’s health-care thinking.

In general, the debate was crazy. Disgraceful, really. The name-calling, the constant interruption, the constant talking past the allotted time, candidates talking as if the bell ringing indicating that their time has expired is only annoying them. It only punishes any candidate who is foolish enough to play by the agreed-upon rules.

Obviously, both Sens. Marco Rubio and Ted Cruz realized that the jig was up on their past strategy of waiting for someone else to try to attack Donald Trump. Rubio especially was loaded for bear by his opposition researchers. He argued, logically and probably based on facts that would more or less check out, that Trump is a liar and a hypocrite who has been on both sides of a great many questions, and whose business practices, including hiring undocumented workers, are unsavory.

The Atlantic’s instant analysis of the debate holds that Rubio dinged Trump up in those exchanges. My gut feeling is that this is not going to move the poll numbers, but we should all admit that we don’t really understand how or why Trump is so dominant in the polls, so it’s hard to know whether anything could bring him down.

The pollsters also tell us that the ever-growing legions of Trump supporters are remarkably loyal, which makes it even less likely that Rubio can peel them away, but we’ll see. The last round of pre-Super Tuesday polls suggested Trump was well ahead in most of the Super Tuesday states, including Florida, which is the second biggest prize and happens to be Rubio’s home state. If Trump beats Rubio in Florida, I don’t see much hope for Rubio. Cruz does appear, at the moment, to have a lead in his home state, Texas.

But if Rubio is going down, he decided to go down swinging. He taunted Trump, describing the Trumpian shtick thus: “I see him repeat himself every night. He says five things: Everyone’s dumb. He’s gonna make America great again. We’re going to win, win, win. He’s winning in the polls. And the lines around the states.”

Trump’s limited repertoire

This is only a slight exaggeration. Every candidate must repeat himself a lot, but Trump has a remarkably limited repertoire and much of it is staggeringly light on policy. The last part of Rubio’s bit above, the reference to “the lines around the states,” led to my favorite portion of the debate.

Trump doesn’t have a health care plan. Go to the issues section of his campaign. Really, go there, you won’t believe what you see. A typical campaign website has position papers. Trump has none. The link to “Issues” takes you to a pretty frightening page of short embedded videos of Trump himself summarizing his positions at a level of detail that you should find insulting.

But he doesn’t even have one of those on health care.

In addition to “Issues,” the site’s homepage has a pulldown menu called “Positions.” I don’t get the difference, but who cares? “Positions” are actual written-out position statements, not videos, but only on five issues, none of which are remotely related to health care (nor many other major issues).

So for Trump’s health-care thinking, we have to rely on what he says in debates and speeches and, I suppose, tweets, some of which have been controversial. When asked Thursday night under Rubio’s prodding to describe his plan for health care, he said, as he always does, that he wants to repeal the Affordable Care Act and replace it with something “much better.” Then he says (and this is a direct quote from the debate transcript): “I want to keep pre-existing conditions. I think we need it. I think it’s a modern age. And I think we have to have it.”

This is gibberish, especially the explanation that “I think it’s a modern age,” which may have some meaning but I can’t imagine what. But, in full context, it’s at least clear that the much better plan that he would propose to replace Obamacare would include the Obamacare feature that requires an insurer to cover any pre-existing conditions that the insured might have, and can’t charge them extra for it.

But when it’s time to describe other elements of the “much better” plan with which Trump would replace Obamacare, he generally mentions only one thing, which he describes, as he did Thursday night, as “getting rid of the lines around each state.”

That weird and confusing phrasing —  about “getting rid of the lines around the states,” which Rubio mocked — as best as anyone can tell means that Trump wants national health insurers to be able to offer standardized plans all over the country, instead of having to meet the particular standards and requirements imposed by individual states. Different states require different things of health insurers, which prevents national firms from offering plans in all states.

Trump believes, and he’s not the only one, that “getting rid of the lines around the states” would enable more insurers to offer insurance in more states, which would lead to more competition, driving prices down, and more choices for customers. Trump has been saying this for many weeks. The idea has been around for years. Views differ on whether it would do more good or harm. But it’s really the only thing Trump mentions when he is pushed to describe his plan to replace Obamacare with something much better.

Dying on the streets

Rubio was pressing him, mockingly, to lay out his whole plan. In addition to “getting rid of the lines” and requiring insurers to cover pre-existing conditions, Trump says that he “wouldn’t allow people to die on the streets” for lack of health care. Sometimes he says “sidewalks,” or both. He often does a shtick about how the other presumably heartless Republican candidates would let people die on streets. When he does that he gets a great ovation from his crowds, who agree with him that a great nation like ours should not have dying on streets.

But I’ve never heard him describe what health care he proposed to include in his plan to keep people from dying on the streets. Thursday night, he was asked, and it turns out there is no plan.

With Rubio pressing in and badgering Trump from the sidelines — the same way Rubio was badgered a few weeks ago by Chris Christie and the way Trump often badgers other candidates — and with CNN’s Dana Bash following up, Trump said his three things: Repeal Obamacare and replace it with something much better, get rid of the lines around the states, and don’t let people die in streets. I always assumed that there was more to his plan, but I never came across the details. And, during the exchange Thursday night, it came out that there is no more. Here’s that chunk of the transcript so you can decide for yourself if I’m missing something. (I’ve done a tiny bit of editing for flow.)

BASH: Mr. Trump, Senator Rubio just said that you support the individual mandate. Would you respond?

TRUMP: I just want to say, I agree with that 100 percent, except pre-existing conditions, I would absolutely get rid of Obamacare. We’re going to have something much better, but pre-existing conditions, when I’m referring to that, and I was referring to that very strongly on the show with Anderson Cooper, I want to keep pre-existing conditions. I think we need it. I think it’s a modern age. And I think we have to have it. (APPLAUSE)

BASH: OK, so let’s talk about pre-existing conditions. What the insurance companies say is that the only way that they can cover people [who have pre-existing conditions and would be more expensive to cover] is to have a mandate requiring everybody purchase health insurance. Are they wrong?

TRUMP: I think they’re wrong 100 percent. What we need — look, the insurance companies take care of the politicians. The insurance companies get what they want. 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 reason is some of the people in the audience are insurance people and insurance lobbyists and special interests. They got — I’m not going to point to these gentlemen, of course, they’re part of the problem, other than Ben [Carson], in all fairness. And, actually, the governor [John Kasich], too. Let’s just talk about these two, OK? Because I don’t think the governor had too much to do with this.

But, we should have gotten rid of the borders, we should have gotten rid of the lines around the states so there’s great competition. The insurance companies are making a fortune on every single thing they do. I’m self-funding my campaign. I’m the only one in either party self-funding my campaign. I’m going to do what’s right. We have to get rid of the lines around the states so that there’s serious, serious competition. And you’re going to see — excuse me. You’re going to see pre-existing conditions and everything else be part of it, but the price will be down, and the insurance companies can pay. Right now they’re making a fortune. (APPLAUSE)

BASH: But just to be specific here, what you’re saying is getting rid of the barriers between states, that is going to solve the problem…

TRUMP: That’s going to solve the problem. And the insurance companies are going to say that they want to keep it. They want to say — they say whatever they have to say to keep it the way it is. I know the insurance companies, they’re friends of mine. The top guys, they’re friends of mine. I shouldn’t tell you guys, you’ll say it’s terrible, I have a conflict of interest. They’re friends of mine, there’s some right in the audience. One of them was just waving to me, he was laughing and smiling. He’s not laughing so much anymore. Hi.

Look, the insurance companies are making an absolute fortune. Yes, they will keep pre-existing conditions, and that would be a great thing. Get rid of Obamacare, we’ll come up with new plans. But we should keep pre-existing conditions.

RUBIO: Dana, I was mentioned in his response, so if I may about the insurance companies…

BASH: Go ahead.

RUBIO: You may not be aware of this, Donald, because you don’t follow this stuff very closely, but here’s what happened. When they passed Obamacare they put a bailout fund in Obamacare. All these lobbyists you keep talking about, they put a bailout fund in the law that would allow public money to be used, taxpayer money, to bail out companies when they lost money. And we led the effort and wiped out that bailout fund. The insurance companies are not in favor of me, they hate that. They’re suing right now to get that bailout money put back in.

Here’s what you didn’t hear in that answer, and this is important, guys, this is an important thing. What is your plan? I understand the lines around the state, whatever that means. This is not a game where you draw maps…

TRUMP:…And you don’t know what it means?

RUBIO: What is your plan, Mr. Trump? What is your plan on health care?

TRUMP: You don’t know. The biggest problem…

RUBIO: …What’s your plan?

TRUMP: … You know, I watched him melt down two weeks ago with Chris Christie. I got to tell you, the biggest problem he’s got is he really doesn’t know about the lines. The biggest thing we’ve got, and the reason we’ve got no competition, is because we have lines around the state, and you have essentially….

RUBIO: …You already mentioned that [inaudible] plan. I know what that is, but what else is part of your plan?…

TRUMP: …You don’t know much…

RUBIO: …So, you’re only thing is to get rid of the lines around the states. What else is part of your health-care plan?…

TRUMP: …The lines around the states…

RUBIO: …That’s your only plan…

TRUMP … Excuse me. Excuse me.

RUBIO: … His plan. That was the plan?…

TRUMP:…You get rid of the lines, it brings in competition. So, instead of having one insurance company taking care of New York or Texas, you’ll have many. They’ll compete, and it’ll be a beautiful thing.

RUBIO: Alright…So that’s the only part of the plan? Just the lines?

TRUMP: The nice part of the plan — you’ll have many different plans. You’ll have competition, you’ll have so many different plans.

RUBIO: Now he’s repeating himself.

TRUMP: No, no, no. I watched him repeat himself five times four weeks ago…

RUBIO:… I just watched you repeat yourself five times five seconds ago…

TRUMP: I watched him meltdown on the stage like that, I’ve never seen it in anybody…

BASH:…Let’s stay focused on the subject…

TRUMP:…I thought he came out of the swimming pool…

RUBIO:…I see him repeat himself every night, he says five things: Everyone’s dumb, he’s gonna make America great again…We’re going to win, win win. He’s winning in the polls…And the lines around the state. (APPLAUSE)

BASH: Senator Rubio, you will have time to respond if you would just let Mr. Trump respond to what you’ve just posed to him…

RUBIO: … Yeah, he’s going to give us his plan now, right? OK…

BASH [to Trump]:…If you could talk a little bit more about your plan. I know you talked about…Can you be a little specific?…

TRUMP: … We’re going to have many different plans because… competition…

RUBIO: … He’s done it again.

TRUMP: There is going to be competition among all of the states, and the insurance companies. They’re going to have many, many different plans.

BASH: Is there anything else you would like to add to that…

TRUMP: No, there’s nothing to add. What is to add?

BASH: Thank you. Thank you both.

Here’s the New York Times’ instant transcript and a Times’ instant fact-check of claims made in the debate.

Comments (35)

  1. Submitted by Sean Olsen on 02/26/2016 - 11:07 am.

    Clear distinctions

    Yes, let’s be clear that Trump’s plan is “gibberish”, while Rubio’s plan is “argle bargle” and Cruz’s plan is “claptrap”.

  2. Submitted by Jim Million on 02/26/2016 - 11:41 am.

    Disgraceful…

    Yes, Eric, if you mean “lack of grace,” not if you mean otherwise.

    I have watched replays this morning, with this conclusion: True positions and passion were outed.

    What I also saw was two Praetorian Gentlemen (Carson and Kasich) flanking two Stentorian Guards with the current Emperor between them, working at looking Imperial. Viewed as Shakespeare, this act was rousing, engaging and cathartic. Think A Midwinter’s Night Dream, here.

    Now, I say all this as proper allusion to the realm of political theatricals. This was a not-for-thought food
    fight, well-staged as burlesque, viewed through my old memories as a young director/stage manager.

    One missing character, however (one I would have featured) was a Fairy Something-or-Other played by Sarah Palin, magic wand and all, to freeze these three in various poses along the way for added audience mirth. Fortunately, we can do that over the weekend with our various devices. Those stills should be fabulous!

    Everyone seems to have had a great time. As I considered the replay, I could only think of this (if not Shakespeare) as mid-19th Century country debates with torches, old crones, young folk with tankards of ale, various farm animals nosing about….and, with a few musket shots for punctuation.

    Teddy Roosevelt likely would have enjoyed center stage last night. I thought it was great!

    If anyone is playing to a younger crowd this year, it’s certainly these guys. Maybe next time one of them will borrow Steve Martin’s arrow prop.

  3. Submitted by Tom Christensen on 02/26/2016 - 11:51 am.

    President Obama predicted

    an all out war in the Republican Party. It was on full display last night. Welcome to the kids table. OMG, help us all if the Republicans make it to the Presidency. Wake up American voters.

  4. Submitted by Neal Rovick on 02/26/2016 - 11:52 am.

    Sounds dangerously like an infringement on states rights.

  5. Submitted by Peter Stark on 02/26/2016 - 12:02 pm.

    Rubio is a completely empty suit. The fact that Cruz and Rubio have only just figured out that Donald Trump has thin skin is incredibly funny. All you have to do is call him out for having stubby sausage fingers and he’ll completely melt down.

    But no, better wait until he’s got a commanding lead in all the national polls, is leading in nearly all Super Tuesday and Post polls, and has already won 3/4 states. The three remaining GOP candidates are frauds and lightweights.

    • Submitted by Frank Phelan on 02/26/2016 - 12:30 pm.

      The Secret Is

      That insurers only want to compete in markets where they can get a slice of the pie large enough so that the health care providers in a given market have to negotiate a discount on their rates, and 1 or 2% isn’t enough for that. Have you looked at a health care bill and seen how much is discounted off the top? That’s because your insurer has a customer base large enough to get that for you. So even if it were legal to buy insurance from Florida or Colorado, you’d find it too expensive.

  6. Submitted by Tim Smith on 02/26/2016 - 12:03 pm.

    I confess

    I have never really understood that argument about buying health insurance across state lines. Every state has different demographics and geography that dictate the cost of health care and thus insurance premiums. Wisconsin and Minnesota are neighbors, but plans and premiums are vastly different. Wisconsin’s population is spread out more than Minnesota where most of the state resides in one metro area. Insurance premiums and health care costs are based on that economy of scale (not on who the governor is, sorry). Someone in Wisconsin buying a Minnesota policy throws off the whole actuarial table. That is why, until the ACA, states have been solely responsible for small group and individual insurance regulation.

  7. Submitted by Todd Hintz on 02/26/2016 - 12:09 pm.

    Health Care

    It’s pretty clear that while Trump’s plan is long on rhetoric and short on details, none of the other candidates have anything better. For that matter, none of the Republicans, whether they’re in Congress or lay people, have anything better.

    Let’s look at their main point, that we should open up competition to plans from other states. All you really get is a plan that some other state doesn’t want either. If a plan from New Jersey sucks, what makes anyone think we want that plan here in Minnesota? And vice versa.

    What would happen if this was implemented is you’ll see a lot of consolidation in the market until we get three large players who offer up half a dozen plans each. Costs will skyrocket as competition decreases and the CEOs demand higher compensation packages because they run a large company. (Does anyone recall our own Bill McGuire and his $1.1 -billion- golden parachute?)

    You’ll also see captured markets, such as the Rochester, Minnesota area, that are dominated by one large player. No one else will want to go into that market and tackle the big monkey, leaving the guerrilla to do what they want with prices.

    This method also does nothing to help insure the poor, the elderly, who are too young for Medicare, the unemployed, and the young.

    But all that is just facts and reason, which it appears whole classes of people don’t respond to anymore. So let me risk the temptation of the moderators to reject my post and simply say–

    Trump’s plan sucks. Universal health care is good! Vote vote vote!

    • Submitted by Tim Smith on 02/26/2016 - 12:30 pm.

      not really

      Regarding your fourth paragraph, isn’t that what the ACA is doing already? consolidation? uniformity in plans with fewer choices? Competition among health insurers is somewhat of a fallacy. Only so many can adequately drive down costs.The bigger you are the more discount you can demand from providers. Adding ten carriers to Minnesota would not make insurance cheaper in long run.

      The Rochester point is spot on, health care costs for that area dictate the cost of health insurance there. That is true everywhere and those in Rochester pay most of the price (the metro bares some of it). Your biggest obstacle to single payer is not health insurers, it is the military industrial healthcare complex. Mayo being one of them.

  8. Submitted by Paul Udstrand on 02/26/2016 - 01:11 pm.

    Huh…

    Well, at least the rest of his platform is solid.

  9. Submitted by Dennis Tester on 02/26/2016 - 01:16 pm.

    Audience conditioning

    This entire exercise served to condition the national audience to expect a less than genteel debate atmosphere in the general election. This will not be Clinton v. Rick Lazio redux where Lazio was shamed out of the senate race for being a meanie to the precious flower Mrs. Clinton.

    The republican candidates were auditioning for the voters, trying to show how they intend to grill Clinton on her many illegal and corrupt practices and it appears that no name-calling or embarrassing truth-telling will be off the table, an atmosphere she is ill-prepared for, thanks to her selection of a weak sparring partner.

    Up until last night, only Trump seemed up to the task and could be counted upon to not pull any punches when attacking Mrs. Clinton. But now Rubio and Cruz have given indications that they are capable of delivering the desired pummeling as well.

    It’ll be fun.

    • Submitted by Jim Million on 02/26/2016 - 02:49 pm.

      It Will Be Fun

      Anything that might get more Americans interested is ultimately beneficial.

      The partisan pain comes in the question: Beneficial for whom?
      Despite all the whistful yearning in these pages, Bernie won’t be on the Presidential Debate platforms.

      So, if she survives FBI/Justice Dept. scrutiny, it will be HRC against one of last night’s fellas. It seems any of those three would do a pretty good job of taking her apart where it might matter. Trump likely has more direct inside dirt on her than the other two, so that contest would be a big brawl.

      Trump gets petty and blatantly preposterous when really pushed. HRC, as all have seen many times, also becomes very nasty when pushed hard. There will be little diplomacy in that contest.

      Given that, my question remains: Which visage would people take with them to the polls?.

      • Submitted by Henk Tobias on 02/27/2016 - 01:44 pm.

        Hillary spent 11 hours

        in front of Trey Gowdy and his band of merry men. They didn’t lay a glove on her. She walked away looking relaxed and refreshed. You think a few insults from Trump will work any better? While the Republican primary votes may enjoy name calling and school yard bullying, the general voting public does not. They want substance in their candidates and that something that NONE of the remaining clowns in the Republican clown car have.

    • Submitted by Dennis Wagner on 02/27/2016 - 08:47 am.

      Sorry

      Looked more like a grade school argument:

    • Submitted by Robert Gauthier on 02/27/2016 - 09:16 pm.

      You seem to think

      That an intelligent woman cannot defend herself against three empty suits? They stand for nothing and they have no plans, save bully immigrants. And two of them are immigrants themselves!

    • Submitted by Bill Willy on 02/28/2016 - 02:21 pm.

      “her many illegal and corrupt practices”

      Be a little more specific. What, exactly, are the many illegal and corrupt practices you’re talking about? Provide some links to non-FOX/Limbaugh/conservative web sites that document the proof, convictions, fines, Senate censures, jail time, etc..

      As far as “delivering the desired pummeling” goes, it’s interesting that that’s a Top Priority for Republicans. . . Nothing the country needs more than a strong conservative man who hasn’t forgotten how important (and fun!) it is to be able to pummel a woman. Especially on national tv (so all his like-minded and tough arm chair truth-telling brothers can watch and high-five themselves or each other as the heaviest blows are landed).

  10. Submitted by Connie Sullivan on 02/26/2016 - 01:19 pm.

    The Republicans don’t know what they would replace Obamacare with, because Obamacare is a Republican invention (by Mitt Romney in Massachusetts) to provide a state-sponsored health insurance plan that would keep private insurance companies alive and thriving. Republicans thus really don’t know what to do about premiums, competition among private insurers, the broad-pool mandate insisted upon by those insurers, and ever-rising health care costs.

    As someone who has experienced it up close: Medicare works. That’s single-payer health insurance, the single payer being, of course, not the different states but the federal government. You want to see a strong arm pushing big discounts? that’s Medicare.

    The U.S. is struggling mightily to preserve capitalism in health care insurance even as it faces the facts that our poor and increasingly our middle classes cannot afford the high-deductible health insurance policies the private insurers are offering on both state and federal exchanges.

    That too many Americans do not understand that Donald Trump knows nothing about health care and has absolutely no plan with which to replace Obamacare is not surprising, given that most Americans can’t really describe Obamacare–or understand its differences from Medicare or Medicaid–in the first place.

    If only any Republican had something solid to offer. But they don’t.

    • Submitted by Tim Smith on 02/26/2016 - 02:16 pm.

      silly really

      Always love the liberal claims that, well, it is a republican idea from Mass. or the Heritage foundation. The ACA is squarely an Obama/Democrat program. Because one republican governor and a liberal dem legislature from a medium sized state decided to compromise on a program, doesn’t mean every republican who ever lived has to endorse it for every state in the union. the point is if that is what one state wanted to do, that’s up to them. The other states have a choice.

      As for Heritage foundation claims, even they have strongly denounced that there is any similarity. It is their largely free market plan on big gov steroids.

      As for medicare for all, Bernie is having a lot of luck selling that to his own party, right? The health care system itself is your biggest obstacle, not health insurance companies.

      • Submitted by David Therkelsen on 02/26/2016 - 07:03 pm.

        ACA’s parentage

        Oh, no. No similarity at all between ACA and Heritage Foundation plan.

        Heritage Foundation plan had universal coverage, individual mandate, pre-existing conditions provision. But other than those tiny details, no resemblance at all between the two.

    • Submitted by Steve Titterud on 02/26/2016 - 02:36 pm.

      As proof of what Ms. Sullivan is saying re: Medicare

      …and costs, just take a look at your latest EOB (explanation of benefits) statement – if you’re covered by Medicare and an additional insurer, and have filed virtually ANY kind of recent claim. Study it a little.

      You will find a radical difference between what the insurer “asks” in its retail pricing submitted with the claim, and what they will actually accept as a profit-taking payment. Of course, there is plenty of chicanery in that retail pricing, but it does give you an idea of what would be demanded if you didn’t have Medicare. It is an astonishing difference!!

      Of course, the insurers can negotiate payment schedules, too, and if you’re a provider who won’t come to heel, maybe they leave you out of their network, where that makes a difference.

      But a single insurer has nothing like the power of Medicare to control prices. That is the cause for some very powerful resistance to “Medicare for all”.

      • Submitted by Jim Million on 02/26/2016 - 08:46 pm.

        Managed Care [Price] Model

        We’ve been under that discount payment model in Minnesota for 25 years, most of the country for a similar period, somewhat shorter in areas of the South, where standard indemnity plans prevailed much longer. The only significant differences lie in the amount of discount per diagnostic code. Medicare has some deeper discounting than ACA qualified plans.

        It’s pretty meaningless to look closely at the “disallowed” figures on any EOB. Each code has an agreed reimbursement rate, so only that net amount matters.

        • Submitted by Steve Titterud on 02/27/2016 - 11:25 am.

          Awareness of retail prices may be limited in usefulness, but not

          …”meaningless”.

          It enabled me, for example, to see by actual examples that Mayo’s prices are lower than the big systems here in the metro area – across the board, in the comparisons I made – quite to the contrary of the public perception.

          And if you are one of those unfortunates who received care while uninsured, you would find that pricing has a real meaning. You’ll be looking at the highest prices in the world, and the vendor will definitely demand it.

          Another advantage of studying that EOB is not only to note the pricing, but to see if you’re being billed for services you never received!!

          • Submitted by Jim Million on 03/04/2016 - 01:06 pm.

            Very pleased

            you read your EOBs…most patients do not, other than to check accuracy of their portion.

            We must remember the discounted number is the significant one. The larger number is filled with a bunch of junk, for several purposes.

    • Submitted by Jim Million on 02/26/2016 - 03:24 pm.

      No, No, No

      As much as I respect Sullivan comments, I cannot accept this one, given its initial faulty premise.

      ACA is a Democrat program assembled by Democrats and their preferred consultants. One cannot dispute the closed-door process of it all.

      Medicare does work well for patients (I am one also). The larger question is will it continue to work well even for us individuals as the program cost increases. Right now, the program has gleaned optimal efficiency from the provider side, for the most part. The Med Sup business is highly profitable for companies selling and underwriting those. That segment is working well, but premiums continue to rise. This year Medica, for example, lowered its Med Sup co-pays, but increased prescription option premiums. In actuarial terms, that means more members are now paying for the drug expense of other members than last year.

      The ACA has become very expensive for states and underwriters, even in Minnesota, where we have a 25 year history of ever-improving HMO efficiency. MNsure has cost us very much money, whether reimbursed by Washington or assessed here. United Health has announced it may drop out of the ACA program, supposedly to be decided this coming summer. I suspect that is a political ploy, given its close relationship with HRC and her original plan; but, it may also be a sincere financial fact.

      So, ACA will definitely be greatly modified starting next year, regardless of White House resident. How so, I don’t know, but can perhaps project at another time.

      Do not expect “Medicare For All” simply because serious people inside and outside government know the pending critical issues in our current 65+ program. At this time, making that program larger, not to mention universal, will not make it better in terms of cost/price.

    • Submitted by Bill Willy on 02/26/2016 - 03:50 pm.

      All three of you are right

      While I agree with Tim when he says, “the health care system itself is your biggest obstacle” (not Republicans, not Democrats, not “the government,” but the health care providers, insurance companies, medical device manufacturers, $4.00 aspirin/pharmaceutical and “support services” gangs), what you’re saying about Medicare being a tough “cost plus a reasonable profit” watchdog reminds me of a prime example in Steven Brill’s “Bitter Pill” article from a couple years ago:

      The average “care provider” (hospitals, clinics, etc.) charge for a common blood test is right around $200; but Medicare says, “Sorry. . . We know how much it actually costs you to perform that test and we’re only going to pay you $16 for it.”

      There is nothing that happens when it comes to provider charges that isn’t equally off charts price gouging. As to the bogus “discounts” insurance companies “negotiate on their customer’s behalf,” if a $184 overcharge on a blood test is the kind of discount they’re negotiating I’d hate to see what would happen if “full retail” were charged for something like, say, brain surgery.

      • Submitted by Steve Titterud on 02/26/2016 - 04:39 pm.

        There are plenty of ways Medicare could reduce costs

        …where it DOES NOT, so we’re not talking about a Medicare that can’t stand improvement, let’s be clear. Here is a pretty good example from my own personal experience relating to medical devices (aka Durable Medical Equipment):

        A prescription calling for a particular BiPAP machine (in the same vein as a CPAP device, but dynamically a little different) was eligible for Medicare reimbursement in excess of $5000, SO LONG AS it was purchased from a certified vendor of DME. The EXACT SAME DEVICE was available from a licensed and certified respiratory therapist – with the same services, and new in the box – for $800, but Medicare wouldn’t pay a dime of it because it wouldn’t have come from a Medicare-approved DME vendor.

        Do a little aritmetic with this particular instance & then project the waste across a wide variety of DME sales, and it is easy to see how many BILLIONS could be saved by application of a little common sense. In the realm of DME alone, the savings could be YUUUGE!!

        Medicare has the structure which could be used to greatly reduce costs, but its power is not uniformly applied, as a comparison of the example at hand with the example of lab tests given above shows.

        So Medicare ain’t perfect, but all the other proposed alternatives have absolutely no chance of making a serious dent in health care costs.

      • Submitted by Jim Million on 02/26/2016 - 09:07 pm.

        Bill

        I urge you to read any typical EOB as well as my note above in reference to Managed Care Model pricing.

        The typical “blood test” payment is around 16-24 dollars, depending on number of tests run.

        The one service area where pricing is very high is Emergency Room billing. There are several reasons for that. In general, not to be trite, the essential reason beyond technology is similar to having a plumber come to the house at midnight rather than noon.

        One factor that most people do not know is a matter of accounting policy. In any large medical service operation, many “spare costs” (those not specifically differentiated or patient specific) are collectively loaded against ER operational overhead.

        The rise of “Urgent Care” came from this practice.
        Most people do not know that “Emergency,” by plan and contractual definition, means “life threatening event.” Urgent Care clearly falls between “Routine Office Visit” and “Emergency;” hence, the care model pricing differentiation.

      • Submitted by Tom Anderson on 02/26/2016 - 09:38 pm.

        The key is

        The average “care provider” (hospitals, clinics, etc.) charge for a common blood test is right around $200; but Medicare says, “Sorry. . . We know how much it actually costs you to perform that test and we’re only going to pay you $16 for it.”

        What it costs is $50.00 to $100.00 and we’re only going to pay you $16.00 for it. Medicare looks remarkably efficient since it pays less than the service actually costs to provide. This explains why more and more doctors are refusing to take any more Medicare patients, they need non-Medicare patients to make up the shortfall.

  11. Submitted by Wade Brezina on 02/26/2016 - 02:08 pm.

    Let’s face it. Health isnsurance in the USA is a racket!

    How can anyone in the Republican party today even discuss health care in any terms other than gibberish. The ACA was a stupid idea from the start. It originated from the Heritage Foundation and is just plain fundamentally flawed. Under what market signals do insurance and drug companies have to drive the costs down or quality of care up? It is a model with no basis of success in reality.

    Consider what happened this year in the individual marketplace in MN. The state regulators approved rate increases of nearly 50% vs less than 5% for large group plans. This is like a barkers carnival game where you guess what cup the pea is under.

    The bottom line is money in politics. There is a reason the Heritage Foundation and all Republicans fought the ACA tooth and nail. They simply don’t care about the health and welfare of anyone other than those who have done done well enough for themselves to be able to afford good insurance that is subsidized by shifting costs onto the public. All they really care about is power. By stirring up a false debate around something that people are as passionate about as health care, they are able to remain in power.

    I challenge anyone who thinks I’m off base on this to take some time to learn about Whittaker and Baxter and what they did to Harry Truman’s plan to give us national health insurance. Not only was their playbook tremendously successful but it has laid the blueprint for the unimaginably successful power grab that has taken place during my lifetime.

    If you care about free enterprise, freedom, and the ability to work hard and improve your life, you simply must get off the couch and make the Bernie revolution happen. It is not about Bernie. It is about getting back control of the government from the people who have figured out that if they can keep people fighting over gibberish, they can pretty much get away with anything they want.

  12. Submitted by Tom Christensen on 02/26/2016 - 03:04 pm.

    Well there you have it.

    Seven years of countless Republicans attempting 50-60+ times to repeal Obamacare, 17 Republican candidates for President, Countless debates (sorry, circus events) and the Republicans still can’t tell us what they would replace Obamacare with. Nothing written down which they can be held to. Not a very secure feeling for those who have real medical issues. Whoever came up with the term “compassionate conservatives” must of had a dream that didn’t come true. They missed it on both halves of the term “compassionate conservative”. Both were given to them by someone in the GOP so it doesn’t have any applicable meaning at all. Narcissistic behavior and no content to offer the voters for the highest office in America. Vote Republican and buy a pig in a poke.

    • Submitted by Paul Udstrand on 03/02/2016 - 12:30 pm.

      You have to remeber

      The republican core and their voters never recognized a problem with health care in the first place. That’s why it was democrats not republicans who dusted off the old Heritage Foundation plan put it into action. Republican simply the repeal of Obamacare as a self correction of sorts, the assumption is that the market will simply recover. The republican almost never have a real plan, the specialize in non-plans.

  13. Submitted by miki polumbaum on 03/23/2016 - 09:17 am.

    As horrific as the Republicans have been on this issue,

    the Obama Administration’s health care policies/insurance policies are nothing to gloat at and romannticize over either.

    The Obama Administration and the Democrats in Congress had plenty of time to go back to the drawing board, really put their heads together, and to concoct and implement a genuine healthcare reform program that would entail Single Payer with Universal Healthcare & Medicare for all Americans that was modeled somewhat after the Canadian Healthcare system, which while not perfect, is far better than the US Healthcare system. Instead, the Obama Administration took the easy way out and passed a warmed-over, 20 year old, GOP0-written health care “reform” bill that was also based on the program that Mitt Romney passed when he was governor of the Bay State.

    Equally, if not more disgracefully, the Obama Administration allowed abortion rights to get thrown under the bus in order to get the present Healthcare “reform” bill passed.

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