Trump's long-awaited healthcare "plan" is a joke
He can barely bring himself to pretend he cares.
PN is supported by paid subscribers. Become one ⬇️
“In two weeks” finally arrived.
That’s the usual time period in which President Trump has, for the last 10 years, promised the arrival of a spectacular plan to reform the healthcare system, one that would solve every problem anyone could identify, whether individual or systemic. Just you wait, he’d say — the plan is coming in two weeks, and you’re gonna love it.
Well now the White House has indeed released what it calls “The Great Healthcare Plan.” Is it great? No. Is it a plan? Not really. It is, however, in its combination of stupidity, ideological derangement, and unseriousness, a near-perfect expression of everything Trump and his party believe about a policy challenge that has bedeviled the United States for decades.
If the White House wanted to enact some kind of healthcare reform, it would put out a document explaining a series of changes it would like to make to the system, then work with Republicans on Capitol Hill to turn those ideas into legislation. That is not happening. There are a few Republican bills rolling around Congress, but no one takes them seriously.
What we have, then, is a bunch of vague statements of principle, some outright nonsense, and a few absolutely terrible ideas.
The very bad healthcare non-plan
The plan (forgive us for using that word) is spread out over a few short documents (here, here, and here). It does contain a few things that look like big ideas, but are immediately baffling.
The biggest is this one: “The government is going to pay the money directly to you,” the plan quotes Trump saying. “It goes to you, and then you take the money and buy your own healthcare.” How exactly is that going to work? We’ll each get a check every month from the government? Is the entire insurance system going to be replaced by health savings accounts?
Worry not: Trump insists that prices will come down, because he says you’ll “go out and buy your own healthcare, and you’ll make a great deal.”
Imagine the future that could be yours. You wake up in the middle of the night with a crushing chest pain. Convinced you’re having a heart attack, your first instinct is to call 911. But wait, you think — I’m an empowered consumer in the free-wheeling healthcare market. As sweat pours down your brow and you struggle for breath, you begin to shop around to decide where you should seek care.
What’s the cost of a triple bypass at St. Joseph’s Hospital? Can I make a deal with them? You check the Yelp reviews on Downtown General to see how many five-star customer satisfaction scores that hospital gets. Then you begin feeling dizzy, and as you slip into unconsciousness, you know that healthcare has finally become great.
This is the ultimate expression of a foundational Republican belief about healthcare, which is that if we could only inject more free-market magic into the system, all the problems that bedevil it would disappear.
We’ll get more into that in a moment, but what else does the Trump plan suggest?
It’s a little hard to understand on the question of insurance. At times it seems to propose eliminating insurance altogether, while at other times it wants to prop up the industry. For instance, Trump says the plan “fully funds a long-neglected part of the law known as the Cost Sharing Reduction program. This measure alone should cut premiums on the most popular Obamacare plans — it’s hard to believe there are any because it’s a hated program, it’s unaffordable — but it’s going to cut them by an average of 10 to 15 percent.”
If you aren’t a health policy wonk you’d have no idea what he’s talking about, but briefly: The Affordable Care Act requires insurers to cover basic care like checkups at no cost, and provided “cost sharing” subsidies to insurers to pay for it without raising premiums. But in the first Trump term, his administration eliminated those insurer subsidies, which led to premium increases. So now he’s reversing himself and restoring this part of the original ACA structure. What an amazing reform! (There’s a helpful explainer here.)
The plan also says Americans should benefit from “the same low prices for prescription drugs that people in other countries pay.” Terrific — and how will that happen? Government price controls, perhaps? It doesn’t say. It also would require providers to post prices for their procedures “in their place of business.” Imagine a kind of McDonald’s menu, but with all the thousands of different treatments one might receive in a hospital.
In fairness, there are some specific and not completely insane ideas included here and there; for instance, it suggests making “more verified safe pharmaceutical drugs available for over-the-counter purchase.” Which might be fine, depending on how that process is streamlined. But it isn’t exactly transformative. Likewise, the plan suggests requiring insurers “to publish the percentage of their revenues that are paid out to claims versus overhead costs and profits on their websites. Again, perfectly fine — that’s called the “medical loss ratio,” and the information is already public.
But nothing in the plan tackles any of the biggest problems in the healthcare system, especially the millions of Americans who lack insurance (a number that will increase dramatically because of the Republicans’ Big Beautiful Bill) and the overall cost of the system.
Trump versus the GOP
It’s quite clear that if someone asked Trump to name two things his “plan” does, he would not be able to.
This has been one of the defining features of healthcare policymaking in both Trump terms: He not only knows almost nothing about the issue, he has no evident beliefs about healthcare; in fact, he couldn’t care less about it.
Shortly after taking office in 2017, confronted with what it would take to follow through on his promise to repeal the ACA, he lamented that “nobody knew that healthcare could be so complicated,” though he seemed to be the only person in America who didn’t know. From time to time the issue bubbles back up to the top of the public’s agenda and he’s forced to answer questions and pretend he has a “plan,” but he’d be much happier if it just went away.
Trump, does, however, have a simplistic but basically accurate understanding of what the public wants, so when speaking off the cuff he’ll say things that make him sound almost liberal. For instance, he repeatedly said he was going to deliver “insurance for everybody,” which would certainly be nice.
“You’ll have healthcare the likes of which you’ve never seen,” he would say, and promised repeatedly to preserve Medicaid and Medicare.
Even if his policies have attacked those programs (especially Medicaid), he gets that what people want from the insurance system is pretty simple. They don’t want to be empowered consumers or healthcare comparison shoppers. They just want to know that when they’re sick they can get treated. They don’t want to be crushed by healthcare costs. If a private insurer can give them that, they’re fine with it, and if a government program gives them that, they’re fine with that, too. Nobody actually says “I like Medicare, but I wish this was a private plan, because I believe so firmly in the free market.”
But that is what many Republican lawmakers believe, no matter how clear the evidence that markets in healthcare produce terrible outcomes. They continue to insist that once we get government out of the way and unleash the invisible hand in all its wisdom, costs will plunge, quality will improve, maddening bureaucracy will melt away, and we’ll finally achieve the kind of security and satisfaction we have longed for.
What they won’t admit, however, is that you don’t have to look far to find populations that have just that kind of security and satisfaction — just go to pretty much any other industrialized country in the world.
While they use a variety of systems, the main difference in structure between us and other developed nations is that they have more government involvement in healthcare. They acknowledge that getting your gall bladder removed is not like buying a car; healthcare is a place where markets simply don’t work, and management by regulation is a necessity. Because they appreciate that, those countries also cover everyone, usually produce better health outcomes, and spend much less than we do.
Trump certainly isn’t going to approve more regulation, unless it’s in the context of a “deal” wherein someone (like drug companies) genuflects before him and gives him a policy concession. But when it comes time to produce something that vaguely resembles a policy blueprint, Trump steps aside and the right-wing ideologues who surround him take over. His only job is to record a brief video, try to stay awake through a White House event on the subject, and then go back to not talking about it for the next year.
Even Trump’s aides know, however, that if all the changes they proposed were actually turned into law, the result would be a political disaster. Which is how we get what we got last week: A plan that is not a plan, released so they can say they have a plan but not actually do anything. And that’s just fine with Trump.
That’s it for today
We’ll be back with more tomorrow. If you appreciate today’s PN, please do your part to keep us free by signing up for a paid subscription.
Thanks for reading, and for your support.
What keeps hitting me is how far the public conversation is from the lived reality of getting care. Switzerland is an incredible country in so many ways, and one thing they get right is transparency: you’re told the costs up front, the procedure details up front, and you walk in knowing exactly what’s happening and why. It’s calm, orderly, and human.
And then you look at the U.S., where the system feels almost engineered for confusion. You’re given minimal information, you’re rushed through the process, and then months…sometimes a year later, the bills start arriving from providers you didn’t even know were involved. It’s not just inefficient; it’s disorienting by design.
What’s wild is that I’ve had smoother, more humane care in places people don’t expect: Italy, the UK, even China. Staff weren’t burned out, facilities were calmer, and the whole experience felt less like navigating a financial trap and more like being treated by actual humans.
Which is why the “healthcare plan” discourse always feels detached. Until the system is built around clarity, access, and dignity (not opacity and extraction) the branding will keep changing while the experience stays the same.
Health care is complicated and Trump and his billionaire buddies aren't invested in it because they know that they can afford A-grade health care with no stress at all on their personal budget.
So I can't say I'm surprised at all that he comes up with a 'plan' that not only fails to pay attention to details but seems unaware that of any detail or even major feature of the subect.