Donald Trump’s executive order diagnosed the primary disorder in American health care.
“The average exchange premium in the 39 States that are using www.healthcare.gov in 2017 is more than double the average overall individual market premium recorded in 2013,” the president noted upon issuing his health care executive order last Thursday. “The [Patient Protection and Affordable Care Act] has also largely failed to provide meaningful choice or competition between insurers, resulting in one-third of America’s counties having only one insurer offering coverage on their applicable government-run exchange in 2017.”
Americans pay more than $10,000 per person on health care expenses annually. This amounts to more than $3 trillion, a figure fast approaching a fifth of gross domestic product, per year. The country that spends the second most, Sweden, spends about two-thirds of what we do per capita. Other Organization for Economic Cooperation and Development nations average about half of what we expend.
We spend like Americans. But we live like Costa Ricans and Cubans, the two other countries that also see life expectancy at 79 years. Yes, we manage to spend about seven times more than the Costa Ricans and four times more than the Cubans only to die at the same age.
Can we get a refund?
It turns out that paying billions on insurance adjusters, malpractice claims, and taxes on medical devices does not actually extend our lives. Who knew? There’s that cliché: work smarter, not harder. It applies here.
The president fixes to fix this. His opponents say he reckons to wreck Obamacare. A distinction without a difference?
His means of doing one or the other involve association health plans (AHPs), short-term, limited-duration insurance (STLDIs), and health reimbursement arrangements (HRAs). The first allows small businessmen to team up to get the cost reductions big businesses receive when purchasing insurance in bulk. The second permits Americans to sign up for plans minus the bells and whistles mandated by Obamacare that drives up price. The third serves as accounts that shield health-care dollars from taxes.
The president’s opponents lose their senses over the common-sense directive.
Sam Berger of the Center for American Progress calls the executive order “sabotage plain and simple.” Eleanor Clift labels it “cynical” and “insidious.” The New Yorker’s Amy Davidson Sorkin accuses Trump of “trying to break the health-care system all by himself.”
But even Barack Obama could not do that. The health-care system broke long before Trump or his predecessor took office. While the legislation that came to bear Obama’s name fixated on redistribution, Trump’s executive order focuses on costs. Given that relatively few people (true even before Obamacare) lack coverage, and very many people regard health insurance as too expensive, Trump addresses the issue from the perspective shared by most Americans. And when politicians focus on costs, the prospects for the uninsured affording insurance improve. When they focus on redistribution, costs rise.
The executive order looks to reverse the cost spike in the wake of Obamacare.
STLDIs, for instance, undermine the one-size-fits-all philosophy inherent in Obamacare’s “essential health benefits.” Like going to CVS for a battery for your remote control and finding only 20-packs of AAs, Obamacare forces Americans to purchase coverage most neither want nor need. This drives costs up. At least you can use each of those 20 AA batteries by the end of the next decade. Does everyone get to use those wellness visits, maternity care, and psychiatrist sessions deemed “essential” by Obamacare?
AHPs figure to deal small businessmen a better hand by allowing them to band together for better pricing and shop across state lines for the best deals. Alas, Trump proposed it, and whatever Trump proposes some oppose.
Ironically, President Obama set up the means by which an executive order could unravel his signature legislative achievement. By keeping the Patient Protection and Affordable Care Act byzantine and vague, Obama gave leeway to the bureaucrats working in the executive branch to bend the law more to his liking.
The downside of that shortsighted strategy comes when the president’s party loses power. Obama counted on universal coverage and decreasing costs. Neither happened. Counting on a political dynasty proved similarly foolhardy.
Hunt Lawrence is a New York-based investor. Daniel Flynn is the author of five books.