Trump Still Only Has “Concepts of a Plan” for Health Care Reform

As an alternative to the enhanced subsidies, which lowered the cost of monthly premiums for eligible ACA enrollees, Trump wants Congress to fund health spending accounts that people can use to buy health insurance. “The government is going to pay the money directly to you. It goes to you, and then you take the money and buy your own health care,” he said in his video announcement, sounding a bit like a Home Shopping Network salesman. It’s not clear, of course, how generous the funds would be for those accounts, or who would qualify.

Trump also wants insurance companies and providers to be more transparent about the costs of services. In theory, that’s fine. Hospitals and doctors’ offices charge different prices to different insurance companies, and often charge still different prices for uninsured patients paying on their own; the same procedure can cost wildly different amounts even in the same hospital, depending on who’s paying. It’s a confusing system that both hospitals and insurance companies employ hundreds of workers to negotiate and navigate. But publishing what providers charge insurance companies is just as likely to drive costs up as down because insurers, being motivated by profits, are always trying to negotiate the highest rates possible. If an insurer sees that another insurer is getting paid more for a particular procedure, then it will demand that rate as well (and if negotiations go sour, patients could find themselves locked out of their preferred health care provider).

The idea of posting prices is also based on a false hope: that patients will shop for the cheapest care, driving costs down. But that’s not how medicine works. People choose their doctors based on factors like convenience, trust, and quality, not just price. They form relationships with their doctors; the longer the relationship, the better the doctor understands their patient’s medical history. So patients are often reluctant to switch, even if it lowers their costs. (Some people might be weirded out by the lowest prices: They want the best health care for themselves, not bargain-basement care.)