Last night, Donald Trump sat down with Scott Pelley on ’60 Minutes’ and made a gloriously confused barrage of promises and wishcasting about taxes, Social Security, ISIL, trade, and immigration. There’s a lot in there, but for my money his most laughable comments were about repealing Obamacare. Here’s the key section:
Scott Pelley: What’s your plan for Obamacare?
Donald Trump: Obamacare’s going to be repealed and replaced. Obamacare is a disaster if you look at what’s going on with premiums where they’re up 40, 50, 55 percent.
Scott Pelley: How do you fix it?
Donald Trump: There’s many different ways, by the way. Everybody’s got to be covered. This is an un-Republican thing for me to say because a lot of times they say, “No, no, the lower 25 percent that can’t afford private. But–”
Scott Pelley: Universal health care.
Donald Trump: I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.
Scott Pelley: The uninsured person is going to be taken care of. How? How?
Donald Trump: They’re going to be taken care of. I would make a deal with existing hospitals to take care of people. And, you know what, if this is probably–
Scott Pelley: Make a deal? Who pays for it?
Donald Trump: –the government’s gonna pay for it. But we’re going to save so much money on the other side. But for the most it’s going to be a private plan and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.
Okay, he’s going to repeal Obamacare, but replace it with a system where “everybody’s got to be covered.” Very Obamacare-ish.
According to Trump, uninsured people are going to get coverage because he’s going to “make a deal with existing hospitals” and “the government’s gonna pay for it.” There’s a word for this exact proposal: Medicaid. Trump probably doesn’t know this, but Medicaid expansion was a huge part of Obamacare. The “deal with existing hospitals” is so unfavorable for doctors and hospitals that many of them do not accept Medicaid patients because it would put them out of business. Does Trump know this? Meh, he doesn’t care.
But that’s just the uninsured. Trump goes on to say that “for the most part,” his plan will be “a private plan and people are going to be able to go out and negotiate great plans with lots of different competition.” If this idea also sounds strangely familiar, it is because this too is already part of our healthcare framework. Trump described the Obamacare exchanges just like Obama did, as increasing competition in the private insurance markets by providing lots of options.
And what would a health reform proposal be like without transparently false promises? Remember, “if you like your plan, you can keep it”? Trump thinks it’s a great idea, and not only can you keep your doctor, keep your plan, you “can have everything!”
Summing Up: Pelley didn’t push hard on any of Trump’s stream-of-conscious proposals, so we don’t know in what way his plan would differ from expansion of Medicaid and Obamacare or how he would avoid the “if you like it, you can keep it” trap. Does anyone think Trump even knows?