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Agreeable Fantasy: Mr. Trump’s Business Acumen Will Solve Complicated Problems Like Health Care

January 5, 2017

I just finished reading an article in today’s NYTimes titled “The Health Care Plan Trump Voters Really Want” and am wondering what will happen when these voters faith in Mr. Trump’s “business skills” vanishes. The article, written by Kaiser Health Care CEO Drew Altman, is based on the findings of six panel discussions held in “Trump territory”. The facilitators of these focus groups were trying to determine what the Trump supporters sought in health care policies… and they found that most of them did NOT want what Trump was proposing based on his appointee’s philosophies and track records. But almost to a person, they were confident that Mr. Trump knew what they wanted and would be able to deliver it. Here are some quotes that I found unsettling:

They trusted Mr. Trump to do the right thing but were quick to say that they didn’t really know what he would do, and were worried about what would come next.

A (health savings) plans has been proposed by Representative Tom Price, Mr. Trump’s nominee to be secretary of Health and Human Services. These voters said they did not understand health savings accounts and displayed skepticism about the concept….When told Mr. Trump might embrace a plan that included these elements, and particularly very high deductibles, they expressed disbelief. 

They were also worried about what they called “chaos” if there was a gap between repealing and replacing Obamacare. But most did not think that, as one participant put it, “a smart businessman like Trump would let that happen.”

They were unmoved by the principle of risk-sharing, and trusted that Mr. Trump would find a way to protect people with pre-existing medical conditions without a mandate, which most viewed as “un-American.”

But once a Republican replacement plan becomes real, these working-class voters, frustrated with their current coverage, will want to know one thing: how that plan fixes their health insurance problems. And they will not be happy if they are asked to pay even more for their health care.

I noted two overarching concepts in these reactions. First, a blind faith in President-elect Trump’s skill at crafting some kind of solution to this problem that would not require them to pay higher taxes or higher health care costs, and a willingness to absolve Mr. Trump of any responsibility for the failure of Congress to find a means of solving this problem. In short, Mr. Trump is the embodiment of the “agreeable fantasy” of a “Great Leader” able to quickly solve complicated and costly problems with no sacrifice required by the American public. In the meantime, Congress is forced to present the “disagreeable truth” that this is not possible. But… the vicious cycle will continue so long as conservative Congressmen can blame liberals and welfare recipients for the problem and liberal congressman (if there is such a thing any more) can blame intransigent Republicans without having to stand up and defend the efficacy of good government.

The way out of this? SOMEONE in office needs to make a commonsense argument that SOMEONE has to pay the bills for health care and there are two ways to do it: through higher taxes or through higher health care premiums…. or MAYBE someone will catch on to Bernie Sanders’ assertion that Medicare for all— universal health care— is the best way forward. In the meantime, the children being raised in poverty remain the group most affected by this logjam— but they don’t vote and they have no lobby so they get no attention.

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