President Trump has been promising a health care plan for months now. But when will we have it? Let's roll the tape:
January 15: "It’s very much formulated down to the final strokes. We haven’t put it in quite yet but we’re going to be doing it soon."
February 5: "I would like to say by the end of the year at least the rudiments but we should have something within the year and the following year."
February 16: "We're doing Obamacare, we're in the final stages. So, we will be submitting sometime in early March, mid-March."
February 27: "We have come up with a solution that's really, really, I think, very good."
So we've gone from immediately to 2018 to mid-March to all done. Today, however, Politico reports that in reality, Trump has no plan at all: "His team has signaled to House Speaker Paul Ryan that they will embrace his health care bill next week, and aides hoped to get a marked-up bill ready."
Since the House bill is apparently what we're going to get, it's worth repeating something I wrote a few months ago. After describing both Obamacare and Ryancare in broad strokes, I noted that their foundations were basically the same:
If you haven't yet noticed what this all means, let me spell it out. The key parts of Obamacare and Ryan's plan are the same. They both (a) rely on private insurance, (b) require insurance companies to cover people with preexisting conditions, (c) encourage people to buy insurance continuously by penalizing them if they don't, (d) provide billions of dollars in federal subsidies to make insurance affordable for low-income households, and (e) rely on Medicaid for the very poorest.
As liberals have been pointing out forever, any kind of health care plan has to have three parts:
- Protection for pre-existing conditions at a reasonable price, so everyone has access to insurance.
- Some kind of incentive for everyone to buy insurance, so insurance companies have plenty of healthy people to balance out the sick people.
- Subsidies so that poor people can afford coverage.
Sure enough, Ryancare has all those things, just like Obamacare. There are differences in the details, but those don't matter very much. What does matter is the difference in cost. Obamacare provides subsidies of about $100 billion per year, while Ryancare provides...something much less. We don't know exactly how much less yet, but certainly less than half of Obamacare, maybe as little as a quarter. This is what makes Ryancare useless, not its overall structure, which is fairly workable. The working poor and the working class can only barely afford insurance even with Obamacare's subsidies. They won't come close with Ryancare's.
But the rich will get a big tax cut, and the middle class will get a nice break on their health insurance. In short order, however, interstate deregulation will almost certainly lead to individual insurance becoming all but useless, and the individual insurance market will probably collapse fairly soon after that. Alternatively, it might collapse even before Ryancare goes into effect, as insurers bail out on Obamacare (why bother with it if it's just going away soon?) and conclude that they can't make money on Ryancare either.
See? It's not so complicated after all. I imagine this is what Paul Ryan has wanted all along.