Insight, analysis & opinion from Joe Paduda

< Back to Home


TrumpCare – initial takes

Okay, time to dig into what this election means for health care.  I’m still working thru how this will affect workers’ comp; my first post next week will focus on that.

To my loyal readers, thanks for your patience while I diverted from health care and work comp and used MCM to discuss the election and its impact on me. For those friends and colleagues who thoughtfully and kindly contributed to the conversation, I deeply appreciate your insights and views. We may not agree and that’s fine as long as we seek to understand.

I’m really working to keep my inner snark under control here, so bear with me folks.

The biggest problem in crystal-balling about the election’s impact on health care is Trump has been all over the place.  He’s advocated for a Canadian-style system, vowed to repeal Obamacare, lauded single-payer, and gone off in other directions enough to convince me he doesn’t have any firm plan.

His party does have a “plan”, at least current Speaker Paul Ryan detailed one earlier this year.  It includes

  • Selling insurance across state lines (an air sandwich if ever there was one),
  • block grants for Medicaid;
  • no mandate but no coverage for pre-existing conditions without continuous coverage;
  • cap employer tax break for health insurance;
  • refundable tax credit for individual purchase of insurance;
  • end the Independent Payment Advisory Board.

Here’s the problem.  Nothing here will reduce the cost of health care. 

The voters who backed the GOP and Trump expect health care costs to come down, insurance to be cheaper, less complicated, and provide better coverage, and the whole system to function better/easier/faster with less hassle.

But mostly they want it to cost less.

These initiatives will not do that.

Reducing cost will require narrower networks (you can’t keep your doctor), lower benefits (what, this isn’t covered?!), price controls (anathema to conservatives) and/or tight utilization control (don’t get between me and my doctor).

Yes, forcing people to buy insurance and not covering pre-existing conditions if they don’t is going to make more people buy insurance and that’s good.  But it’s still unaffordable for many, and they will won’t sign up.

What does this mean for you?

It’s easy to criticize; now that Trump et al own this, they’re going to see just how hard it is to fix health care.



8 thoughts on “TrumpCare – initial takes”

  1. Two fundamental characteristics of a strong leader:

    1. He/She brings out the best in those with whom they come into contact. Trump does exactly the opposite.

    2. They have a clear agenda and some idea how to get there. No one I speak with, whether they voted for or against him, either believes or is sure of anything Trump says or has said.

    Spent a quiet, somber day on the battlefield at Gettysburg yesterday. We have survived worse than Trump.

  2. Joe, I agree. It seems the majority of Trump’s supporters blame Obamacare for the hike in insurance premiums. Do they not remember they could not get individual coverage prior to ACA? Not without going through a very long underwriting process and not if they had even the slightest bit of pre-existing condition. Coverage was just as expensive for individual non-group coverage prior to ACA. Obama has not “fixed” healthcare. He tried. It will take a lot more to fix healthcare. He left it with commercial insurance companies who have purposely manipulated healthcare administration to be profitable. I don’t think they can be trusted to carry out the mission of the ACA, affordable care for all.

  3. Joe,
    One of my concerns with ACA has always been that the demand for care was increased materially with no increase in supply. This is a recipe for higher costs. Obama should have included incentives to increase the supply of physicians by assisting in the costs of education and decreasing disincentives to become a physician such as overly onerous medical malpractice laws. The latter would have hopefully reduced defensive medicine as well. I know there is more but these two items would have helped reduce costs.
    Lastly, it will be tough to eliminate the ACA without a new approach that is not window dressing. Those positively impacted by ACA should demand that if they can be heard.

    1. Hi Jeff – thanks for the comment. I’d suggest the problem doesn’t seem to be oversupply of providers. You may recall the IOM study some years back that noted about a third of healthcare services are wasted as there’s no medical justification for them. In addition a recent NCCI report indicated there is no delay in access to care for work comp claimants due to “crowd out”.

      as to med mal, my information indicates it really isn’t near as much of an issue as some would indicate. I’ve posted on that in years past; you can find it by searching in the search box on the home page.

  4. Can anyone explain why the cost of services in healthcare are so incredible inconsistent? It seems our pricing is based on what we have to pay for the uninsured opposed to the underinsured.

      1. People are sick, technology and drugs are expensive, corporate greed, denied/unpaid medical claims, EMTALA… list goes on and on

  5. As a physician practicing 30 years I remember a time when I could see a patient pick up the phone schedule the diagnostic or lab test have results and 48 hours and get 80% of my bill paid within 21 days

    That system had little to do with the current layers of bureaucracy that occurred after managed-care, Marriott international found out a long time ago it costs more to say no then to say yes with the understanding that those physicians were trusted and had a dependable outcome history

    In the last two years our reimbursement as close to 50% of what it was a 1986 and patient’s co-pays and deductibles have gone out of control

    Physicians overhead continue to climb while their income is less than what they made 30 years ago

    Obama care did absolutely nothing for physicians or the patients they serve, but they did continue to make carriers a lot of money

Comments are closed.

Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



© Joe Paduda 2024. We encourage links to any material on this page. Fair use excerpts of material written by Joe Paduda may be used with attribution to Joe Paduda, Managed Care Matters.

Note: Some material on this page may be excerpted from other sources. In such cases, copyright is retained by the respective authors of those sources.