In which I (don't really) defend Donald Trump for not knowing how complicated healthcare can be.
In remarks at a press preview of his budget priorities on Monday, President Donald Trump teased the idea that, after working with his team and in consultation with Republican governors, he is nearly ready to unveil his plan to repeal and replace the Affordable Care Act.
“We have come up with a solution that’s really, really, I think very good,” he said, before proceeding to say nothing about what that solution looks like. One issue, according to Trump, is that health insurance policy is difficult. “It’s an unbelievably complex subject, nobody knew that health care could be so complicated.”
Needless to say, this is utter horseshit. Many, many people know just how complicated healthcare policy can be (and yes, I prefer to use the single word "healthcare" as opposed to "health care". Get over it).
However, until around October 2013, I was not one of them.
...two or three years ago, if you asked me how the U.S. healthcare system should run, I would've said something like:
"Get rid of the confusing, overlapping mish-mash of insurance companies, Medicare, Medicaid, private insurance, bla bla bla and replace it with a single program which covers everything for everyone. It'd be paid for by raising people's taxes, but everyone would still save money because those taxes would cost less than what they were paying beforehand due to there being no more price-gouging insurance companies and only one, much more efficient system to keep track of!"
...The thing is, I've learned a lot over the past 2 1/2 years. I've learned about premiums and deductibles. I've learned about co-pays and co-insurance. I've learned the difference between HMOs, PPOs and EPOs (ok, I'm still fuzzy on EPOs). I've learned about risk pools, risk corridors and risk adjustment. I've learned about the 8 different thresholds for Medicaid eligibility in each state, and the fact that Medicaid has a different name in each state. I've learned about MAGI, MOOPs, OEPs, SEPs, CO-OPs and COBRA. I've learned the difference between the HHS, CMS, the CBO, the CDC and the ASPE. I've learned the difference between a bundled dental plan and a standalone one (something which even CMS seemed to have trouble with last year).
Three years ago I wasn't quite sure what an "actuary" was. Six months ago I was flown out to Atlanta to be a keynote speaker before the Society of Actuaries annual convention.
My point is, the past two and a half years have been a massive crash-course for me about how insanely complicated the American healthcare industry is.
So, on that level, I actually agree that most average folks probably don't know know a whole lot about how complicated healthcare can be.
Here's the difference, though:
MOST PEOPLE DON'T RUN FOR PRESIDENT, EITHER...especially on a platform of claiming to know every subject better than anyone else on the planet.
If you're going to run for President of the United States, you had damned well learn something about the policies you'll be dealing with if you win, and you should learn something about them before you become President, so that if you do win, you'll actually have the slightest clue what the hell you're talking about.
Tragically, not only didn't Trump have a clue WTF he was talking about a year ago, he doesn't have a clue today either, nor is he willing to actually learn anything about it. That means that he's leaving all of his policy decisions up to a bunch of other people...some of whom may or may not know what they're talking about, but few of whom actually have the best interests fo the American people in mind regardless.
Knowing a subject thoroughly doesn't necessarily mean that you'll implement good policy because of that knowledge, if you don't care what happens to those impacted by it.