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Totally nuts: Trump again calls for trashing Obamacare without a viable alternative

Totally nuts: Trump again calls for trashing Obamacare without a viable alternative
President Trump, at a March 26 meeting with Senate Republicans, says he's determined to eliminate Obamacare but is still "coming up with plans" to replace it. (Chip Somodevilla / EPA-EFE/REX)

Insanity, they say, is doing the same thing over and over and expecting a different result.

Ladies and gentlemen, I give you the president of the United States.

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The Affordable Care Act, which extended health coverage to about 20 million uninsured Americans and protected patients with preexisting conditions, is “a disaster for our people,” President Trump said Wednesday, following up on a tweet in which he called on Republicans to once again try to repeal the healthcare-reform law.

His renewed interest in healthcare comes as his administration announced this week that it supported a conservative judge’s December ruling to wipe out Obamacare completely, based on a technicality involving the individual mandate, which Trump already has eliminated.

“If the Supreme Court rules that Obamacare is out, we will have a plan that is far better than Obamacare,” Trump said Wednesday, a day after declaring that “the Republican Party will soon be known as the party of healthcare.”

This would be the same Republican Party that already failed to repeal and replace the Affordable Care Act on Trump’s watch, and, when President Obama was in power, unsuccessfully voted more than 70 times to scrap or modify the healthcare law.

And here we are again.

Another run at getting rid of protections that polls say most Americans like.

Another attempt to strip coverage from millions of people.

Another reckless move to screw up the healthcare system without a viable replacement on the table.

I asked Vivian Ho, director of the Center for Health and Biosciences at Rice University's Baker Institute for Public Policy, if it made sense to strike down a law that touched the lives of a huge number of Americans without having something better to offer.

She countered: “Does it make sense to start a hip replacement surgery without the prosthesis ready to insert when it’s time to be implanted?”

Which is to say, only a fool would operate under such conditions.

Again, I give you the president.

Trump’s pledge this week to draw up “a plan that's far better than Obamacare” echoed his promises during the campaign that he would provide “insurance for everybody” and “everybody’s going to be taken care of much better than they’re taken care of now.”

An added benefit: Trump said during the campaign that his healthcare plan would be “a lot less expensive” than the roughly $3.5 trillion currently spent annually on healthcare in this country.

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To date, he hasn’t proposed a single change that would accomplish any of these goals.

On the other hand, Republican lawmakers had their you-know-whats handed to them by voters in the last election largely because of their misguided efforts to mess with healthcare.

It’s such a spectacularly bad idea to trudge down this road again that you have to wonder if Trump has contempt for the American people.

That includes members of his base, whom he’s obviously trying to please politically but who would get reamed just as badly as everyone else, maybe more so.

Mark Duggan, a healthcare economist at Stanford University, pointed me toward last year’s Obamacare enrollment numbers. A little over 253,000 people in New York found coverage via an Obamacare exchange.

In Florida, meanwhile, the number of enrollees topped 1.7 million.

“I don’t think most people understand this,” Duggan said. “You take away the Affordable Care Act and you’re going to really hit Trump country.”

He added: “Florida is kind of an important state for anyone thinking about being reelected in 2020.”

A 2017 analysis by the Associated Press found that nearly 70% of those who benefited from cost-sharing subsidies under Obamacare lived in states Trump won the year before.

Meanwhile, polls consistently show that members of both parties support Obamacare’s protections for people with preexisting conditions, as well as other provisions such as a cap on out-of-pocket expenses and parents being able to cover their kids until they turn 26.

Trump wants to do away with all that, without any new safeguards to keep people from being wiped out financially by a medical problem.

And the millions of people who now rely on Obamacare for coverage? Yeah, whatever. Cry me a river.

Nobody is arguing that the Affordable Care Act is perfect. Clearly there need to be measures to limit price increases, although that became significantly harder after Trump ditched the individual mandate, which keeps costs down by spreading risk across the greatest number of people.

Democrats have been saying for years that they’re open to working with Republicans to improve the law — something Republicans have steadfastly refused to even consider.

Now Democrats are growing bolder in calls for a Medicare-for-all system, which Trump and his allies deride as “socialism” but which is in fact the same approach taken by nearly every other developed country.

“We’re coming up with plans,” Trump ambiguously said Wednesday, just as he’s been saying for years.

Yet neither he nor any other Republican has detailed a healthcare plan that would cover as many people as Obamacare or offer people as much protection. That’s not fake news. That’s just a fact.

It seems trite to comment that if you’re not part of the solution, you’re part of the problem. But the sentiment is apt.

Republicans controlled the White House and both chambers of Congress for two years and were unable to come up with a workable healthcare plan.

“They don’t have any specifics because it’s hard,” Duggan said. “Healthcare is hard. There’s no silver bullet.”

Jonathan Skinner, a healthcare economist at Dartmouth College, said the Affordable Care Act had “already become the status quo,” so repealing it at this point could be catastrophic for the healthcare system.

“It’s not just patients who will suffer,” he said. “Hospitals are reaping large benefits from treating Medicaid patients who, prior to the ACA, were uninsured. Medicaid may not pay much compared to commercial rates, but it’s better than no payment at all.”

Terminating the law, Skinner said, “would be a Brexit-sized transformation of healthcare, with providers, patients and insurance companies upended.”

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Kind of crazy, in other words.

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