Given the President-Elect's interview with the Washington Post this weekend, I find myself as skeptical as I am curious. Firmly committed to the proposition that one plus one must always equal two, even in Washington, and unwilling to accept tales of unicorns or fairy dust, I doubt Trump can deliver on his promises.
Not that we've seen the details of the alleged plans of either Trump or congressional Republicans, but Trump SAYS his plan will provide "insurance for everybody," that it will have "much lower deductibles," that it will be "simplified," "much less expensive," and "much better," presumably in comparison with insurance under the Affordable Care Act. Much of the reduced costs are to come from price negotiations with pharmaceutical companies. He specifically rejected the philosophy of "if you can't afford it, you don't get it," saying "that's not going to happen with us." He clarified that his plan does not involve cuts to Medicare. The whole plan is "very much formulated down to the final strokes," so we should be seeing the details soon. In the same interview Trump talked about "great middle-class tax cuts," and building the wall on the border with Mexico.
Given Trump's already established history of later denying words we've all heard and actions we've all seen, I think it is important to document carefully what he's promised here.
"Everybody" is a lot of people. He didn't say it explicitly, but "everybody" presumably includes people with preexisting medical conditions, always an expensive stumbling block. If insurers can't deny applicants who already have medical needs, then presumably the Trump plan will require younger and healthier people to buy insurance. This comes under that heading of "one plus one must equal two," since the increased expenditures by insurers must somewhere be offset by increased income or by reduced costs. The government could, of course, directly subsidize insurance for applicants with preexisting conditions, but with a major tax cut also promised, this seems unlikely.
However the Trump plan accomplishes this, we must presume the overall package will be radically different from the existing Affordable Care Act, still slated for demolition. Odd, though, that day by day the supposed "replacements" for the ACA come to look more and more like the ACA.
Whether or not the GOP will put up with any of this is far from clear. Frankly, Trump is proposing a major government intervention in the health insurance and pharmaceuticals markets. Accomplishing what he's promised, by any means, would be nearly miraculous. Accomplishing what he's promised while operating within free-market economics might amount to an invisible dragon in the garage.
The United States has one of the most expensive, least efficient, least accessible health care systems in the world. Families are still routinely bankrupted by catastrophic illnesses. Any significant steps to bring the U.S. more in line with other industrialized nations would be welcome. But success will be measured by tangible results, not by the number of magical spells uttered.
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