On Thursday, Trump gave a speech touting an executive order that is supposed to deliver us all to health care nirvana. Apparently unable to ignore the elephant in the room, he mentioned the lawsuit filed by Republican states — supported by his administration — that seeks to nullify the entire Affordable Care Act:
I’m in court to terminate this really, really terrible situation. If we win, we will have a better and less expensive plan that will always protect individuals with preexisting conditions. If we lose, what we have now is better than the original — the original version of Obamacare, by far. Much better. Much better. Again, we will always protect patients with preexisting conditions.
This lawsuit will stand a much better chance of succeeding once he fills the Supreme Court seat opened up by the death of Ruth Bader Ginsburg. If it does succeed, the lawsuit will kick 20 million people off coverage, take away subsidies that make coverage affordable for millions more, reinstate the Medicare prescription drug “doughnut hole,” disallow young people from staying on their parents’ insurance and remove the protections for people with preexisting conditions that the ACA created for the first time in U.S. history.
But Trump has a “better” plan. Just like the better future you’ll have once you give your life savings to Trump University to learn his real estate secrets.
In the software industry they call this “vaporware” — a product announced with great fanfare that never actually exists.
I would point out that the ACA is over 900 pages long, as befits a law that sought to re-engineer an impossibly complex system. As Trump himself marveled when he first tried to repeal it, “Nobody knew health care could be so complicated.” Everybody knew that, except for him.
Trump’s executive order, on the other hand, is not complicated at all, nor is it a “plan.” After a few pages extolling the fantastic work his administration has done on health care, it says it will do things like lower costs and expand access. How? Don’t ask.
It’s as though I said “I have a plan to become a billionaire”; you said, “Interesting — how will you do it?”; and I replied, “Step one: Become a billionaire.”
I want to focus in particular on this part:
Sec. 2. Policy. It has been and will continue to be the policy of the United States to give Americans seeking healthcare more choice, lower costs, and better care and to ensure that Americans with pre-existing conditions can obtain the insurance of their choice at affordable rates.
It is already the law that people with preexisting conditions are protected, the very law Trump is trying to overturn. It’s as though Trump walked into a liquor store, pointed a gun at the cashier, and said, “It has been and will continue to be my policy that armed robbery is wrong. Now give me all the money in the register.”
But there’s one more piece of this “plan.” Trump said in his speech that in the next few weeks the government will be sending $200 prescription drug discount cards to 33 million Medicare beneficiaries. “Nobody has seen this before,” he said. “These cards are incredible.”
Given that doing so would cost $6.6 billion and the president can’t simply do that without an act of Congress, if it actually happened it would almost certainly be illegal (the White House claims they can do it through a program they’ve proposed but that does not yet exist, I kid you not). Furthermore, a one-time $200 payment does nothing to solve the enormous problem of high drug costs.
And there’s a back story here, which is that the administration attempted to negotiate a deal with drug companies to lower costs, but the deal fell apart. Why? As the New York Times reported:
Mark Meadows, Mr. Trump’s chief of staff, insisted the drugmakers pay for $100 cash cards that would be mailed to seniors before November — “Trump Cards,” some in the industry called them.Some of the drugmakers bridled at being party to what they feared would be seen as an 11th-hour political boost for Mr. Trump, the people familiar with the matter said.
So the administration wants to do it anyway — which, to repeat, they can’t legally do.
I’m reasonably sure that the entire reason this happened at all is because of how Trump was humiliated in an ABC News town hall earlier this month. When he claimed that he would soon release a fantastic health care plan, host George Stephanopoulos pointed out that for years he has said his health care plan is about to be delivered, usually “two weeks” hence from whenever he’s speaking, yet it never comes.
Trump replied weakly that “I have it all ready, and it’s a much better plan for you.” Somehow the audience refrained from bursting out in a gale of derisive laughter.
Following that debacle, Trump probably ordered his aides to come up with something he could call a “plan,” and this is what they delivered.
In its way, it’s an appropriate coda to Trump’s efforts on health care, a combination of lies and cruelty, stopping short of outright cataclysm only because he and Republicans are too incompetent to follow through on the promise they’ve made for so long to drop a nuclear bomb on the system.
But as always, Trump has faith that there are enough simple-minded marks out there to allow him to pull another con. That faith has gotten him pretty far in life, but his luck won’t last forever.
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