The public debate over how to protect patients with expensive medical conditions is so muddled and uninformed that sometimes President Trump’s critics end up matching his ignorance and muddle‐headedness.
The most recent controversy concerns (what else?) a pair of missives by the Tweeter‐in‐Chief.
It is hard to argue Trump’s words comport to reality. He seems to be taking credit for ObamaCare’s (purported) ban on insurers discriminating against enrollees with preexisting conditions. While he has seemed to suggest in the past that he likes those parts of the Affordable Care Act, his supporters have spun his remarks by saying, no, Trump wants to take care of people with preexisting conditions in a different way. Fine.
The only credible claim Trump could make in this area, however, is that the changes his administration made to short‐term, limited duration plans have improved access to care. But while such renewable term health insurance can make coverage more secure for those who develop expensive conditions in the future – and can therefore make the problem of preexisting conditions smaller – they can’t really help people who already have preexisting conditions, for the same reason fire insurance can’t really help someone whose house has already burned down. The phrase preexisting conditions rather unhelpfully clouds this fact that some medical conditions are simply not insurable. People who actually want to get sick people the health care they need should drop the phrase from their vocabulary and speak only of insurable versus uninsurable medical conditions.
Trump’s critics are little better. A smattering:
Trump clearly does not care to get his facts straight. But neither do his critics. They ignore the critical distinction between insurable and uninsurable medical conditions. They ignore that markets have done a better job of preventing preexisting conditions than the government on which they pin their hopes for the sick. They ignore that the ACA’s (purported) protections for people with preexisting conditions literally ration care to the sick outside the law’s “open enrollment” period. They ignore that those same “protections” are forcing ACA plans into a race to the bottom on coverage for multiple sclerosis and other illnesses. Finally, they ignore that Democrats are literally trying to throw people with preexisting conditions out of their health plans and leave them with no coverage for up to 12 months, while Republicans have prevented Democrats from throwing people with preexisting conditions out of their health plans. I wrote about those efforts in the Wall Street Journal in 2018. The New York Times reports on those efforts here.
Like I said, it’s a muddle. Trump makes so many errors because he just assumes he’s right. Trump’s critics make so many critical errors because that’s how orthodoxy works. So long as everyone you like agrees, you don’t have to think too much. Which is really not all that different from Trump’s approach.