Trump Says He Knows About Health Care, But Some Of His Facts Seem Alternative
Lost in all the coverage of the firing of FBI Director James Comey last week were a pair of in-depth interviews President Donald Trump gave that included lengthy comments on health care 鈥斅爋ne with and the other with .
He acknowledged to Time interviewers that health care was not an area of expertise in his previous job. 鈥淚t was just not high on my list,鈥 he said. But he added that 鈥渋n a short period of time I understood everything there was to know about health care.鈥
Not really.
Among the president鈥檚 more questionable claims was his description of the House-passed health bill as 鈥淵ou鈥檙e going to have absolute coverage.鈥
The last full estimate from the predicted that a previous version of the bill would result in 24 million fewer people with insurance after 10 years.
Trump also told The Economist that 鈥渨e鈥檙e getting rid of the state lines,鈥 a reference to allowing health insurers to sell across state lines. Not only is that not in the GOP bill, many experts agree such a policy to increase competition.
Possibly the most curious comment was this one, also in The Economist interview: 鈥淸T]his was not supposed to be the way insurance works. Insurance is, you鈥檙e 20 years old, you just graduated from college, and you start paying $15 a month for the rest of your life and by the time you鈥檙e 70, and you really need it, you鈥檙e still paying the same amount and that鈥檚 really insurance.鈥
鈥淗e seems to think it鈥檚 like a life insurance policy, which you can buy at a certain age and it keeps you at a fixed premium dollar forever,鈥 said Gail Wilensky, a health economist who ran the Medicare and Medicaid programs under President George H.W. Bush. Except 鈥測ou can鈥檛 buy health insurance that way,鈥 Wilensky said. 鈥淓ven if you stay continuously insured, that鈥檚 just not how it works.鈥
On the other hand, Wilensky said, it might not matter all that much how well a president understands the intricacies of health policy. 鈥淚t matters whether he thinks it鈥檚 important,鈥 she said. The president she worked for was much more comfortable on issues of foreign relations and defense. 鈥淚t wasn鈥檛 that he didn鈥檛 care鈥 about health, she said. 鈥淗e just didn鈥檛 know that area the way he knew other areas.鈥
Jonathan Oberlander, a health policy professor at the University of North Carolina-Chapel Hill, points out that a deep understanding of a subject by itself is not enough to produce policy change.
鈥淏ill Clinton thought he knew health policy, and look at how that turned out,鈥 he said, referring to the collapse of his health reform plan in Congress in 1994. Still, 鈥渋gnorance surely doesn鈥檛 help,鈥 he added.
David Blumenthal, president of the Commonwealth Fund and co-author of on presidents and health care, agreed with both Wilensky and Oberlander.
鈥淎 president has to know enough to sell the plan鈥 to Congress and the public, he said. 鈥淏ut presidents can make mistakes by getting too deep in the details.鈥 He pointed to not only Clinton but also President Jimmy Carter as chief executives who got mired in the small print of health policy.
At the same time, however, Blumenthal said that a president has 鈥渢o lay out principles and parameters that the Congress knows if they meet he will sign the bill.鈥 And while Trump has done that, 鈥淚 don鈥檛 think he鈥檚 been entirely consistent with what he鈥檚 said, so it鈥檚 not clear how much the Congress is being guided by his principles,鈥 he said.
One health issue Trump is clearly not ignorant about is his power to stop paying insurance companies who are providing help to some low-income policyholders in the health insurance exchanges. The 鈥溾 are the subject of a lawsuit that was appealed by the Obama administration, and Trump could, in fact, stop the payments by dropping the appeal.
Insurers say about whether they will get that money is a key reason they are asking for higher rates or dropping out of markets.
Trump did not help allay that uncertainty. He told The Economist聽that 鈥渨e don鈥檛 have to subsidize it. You know if I ever stop wanting to pay the subsidies, which I will.鈥