The Washington Post Interview
The WaPo published yesterday an interview with Trump in which he drops the bombshell that his team is almost finished with their plan for an ACA replacement that will cover everyone, with lower deductibles. Joan McCarter already has a frontpager on this, which is well worth reading.
What to make of this interview? Is Trump really about to come out for universal health coverage? Is the Pope really Catholic?
The Perspectival Vortex
The Rs can and should propose Medicare Advantage for All. They could do this in a way that gets them populist cred for universal health care, without sacrificing, even a little bit, the interests of the insurers. They do this by providing govt-guaranteed and paid for universal coverage, but through private insurers. The industry gets to socialize the risk and privatize the profits. The costs are born partly by ballooning the deficit, now that we have an R president and R Congress and deficits don't matter. The industry, while it has to provide everyone with insurance, is, crucially, left in control of what that insurance actually means in terms of health care it has to pay for. Demand management takes care of whatever cost reduction they choose not to load onto the deficit.
At least as far as our politics go, we live at the bottom of Plato's Cave. Everything you see before you in the political landscape is a parade of the shadows of shadows of unreal dummies and mock-ups. We didn't change the name "Medicare" as the actual program, complicated and indirect even at its origin, had more and more wheels and subsystems added to it to bring it further and further from the social insurance it (sort of) started out as. Not that we were willing to be frank about social insurance even back then, as we were already very careful to not allow the word "social" anywhere in the name of this social insurance. We called it Medicare precisely because that name has no ideological content.
Medicare today is largely already administered through Advantage, the program that has the govt pay private insurers rents for doing demand management to deny patients care. There is absolutely nothing but a now-meaningless label in the way of Rs enthusiastically getting behind extending Medicare Advantage to all recipients of the program, and then extending Medicare to cover everyone. They outmaneuver the left, and get the industry its ideal public private partnership, all at one go. There would be no problem at all created by choosing to avoid or embrace any label at all for this program of theirs, as none of the labels mean anything, promise anything enforceable. They could call it single payer if they want, or shout their denunciations of “Single Payer” even as they propose a system in which the govt pays for all medical care for everyone, and they would be no more guilty of obfuscation than anyone else. Is Medicare Advantage single payer? is it social insurance?
That said, we live at the bottom of Plato's Cave. Neither Trump nor the Congressional Rs are anything but shadows of shadows of puppets and dummies. Trump may have meant nothing at all, there is no plan for universal coverage, and this might just be his latest bit of verbal diarrhea. Even if Trump and his people are dead serious and actually have a plan such as I outline, the more conventional Rs may balk at the label, and make stopping Medicare Advantage for All the hill they are willing to die on.
Who knows. Welcome to the Perspectival Vortex. Hope you brought a towel.