In 2016, candidate Donald Trump promised to repeal Obamacare and replace it with “something terrific.” The replacement never materialized. The repeal, however, has been making progress in a piece-by-piece fashion.
President Trump has made a frontal assault on the Affordable Care Act by asking the U.S. Supreme Court to strike it down altogether. As it happens, Obamacare has become popular, and so, with the next election approaching, Trump badly needs a replacement.
Let me offer ideas. Some elements of my Trumpcare 2020 plan may sound heartless and extreme. But several fit policy changes the administration has already put in motion.
Without further ado, here it is:
— Raise the Medicare eligibility to 85. Doing so would spare taxpayers the expense of subsidizing two more decades of older Americans’ medical care. Since people generally become more medically vulnerable after age 65, and affordable coverage would be impossible to find, certainly in the face of preexisting conditions, more elderly would die early for lack of health care. That would save still more money.
— Get rid of the Obamacare rule requiring all insurance plans in the federal marketplace to cover preventive services without cost to the patient. Examples include mammograms, blood pressure screening and testing for Type 2 diabetes. Not checking for these things would encourage the progress of chronic and terminal diseases, thus removing expensive Americans from the health care system.
— Let states cap Medicaid spending for certain low-income adults. This would cut health benefits for millions who received coverage under the ACA. Actually, Trump has already made this change. Congress would not do it with legislation, but he did it administratively. Curbing health care for low-income Americans younger than 65 would ensure that fewer of them reach the age of Medicare. In any case, the working poor don’t pay federal taxes.
— Provide full funding for homeopathic miracle cures. Arnica montana gel is said to relieve pain from osteoarthritis. Raspberry ketone pills claim to burn body fat. African mango supplements lower blood cholesterol, so they say.
Do these things work? Ask Dr. Google. There are lots of websites on which he says yes. And your cure’s costs fall well below Big Pharma’s price points.
— Subsidize fast food diets. Federal vouchers could be issued for the purchase of sweetened soft drinks, triple-bacon cheeseburgers, corn dogs and anything fried in hydrogenated fats.
Here again, Trump is already on the case, having announced plans to roll back Michelle Obama’s rules requiring that school lunches include healthy fruits and vegetables. While we’re at it, let’s repeal laws requiring the use of seat belts.
— Eliminate clean air and clean water programs. Though this initiative is already well on its way in the Trump administration, far more work can be done. The long-term strategy is to grow the environmental hazards that shorten lives. As already noted, death is cost-effective.
— Stop taxing cigarettes and alcohol. Cigarettes should actually be subsidized.
Research confirms that smokers ultimately save taxpayers money. The French government found that smokers may cost a lot in end-of-life medical care, but their lives are shorter. That means they have less need for pricy interventions common among the old — hip replacements, for example. By dying young, smokers also spend fewer years collecting retirement benefits.
Trump understands that with each passing day, the political risks of offing the ACA in broad daylight become greater. He must now pray that the Supreme Court doesn’t deep-six Obamacare before Election Day. Toward that end, he recently told the justices that there’s no hurry for a ruling. (After the election, no problem, we can assume.)
But in case of a political emergency, he can use my plan. Trumpcare 2020 is there for the taking.
Follow Froma Harrop on Twitter @FromaHarrop. She can be reached at firstname.lastname@example.org.