Donald Trump’s Talk on Health Care Is Not Matched by His Plan

Mar 04, 2016 · 71 comments
T. Ramakrishnan (tramakrishnan)
President-Elect Trump should be firm on his advice to the Congress that Repeal of Obama Care should be passed only with a Replacement ready at hand. The latter should conform to Trump's prescription-promises: Better Care, Less expensive and no bureaucracy-Govt. or Insurance Company. If the Congress proposal falls short, he should veto it and sends his own plan. The Canadian* (and British-Scottish**) plan meets his prescription.
POTUS Trump won the elections with votes of both parties. It would be befitting if he fulfills his first promise with a bipartisan vote.

*The members of the Congress enjoy a health Care system based on this Single Payer system. What is good for the goose should be good for the gander too.
** The British-Scottish system is somewhat similar to the VA system. Despite problems of physician shortage, the system is very popular with the Veterans.
G.Kaplan, MD (Cleveland, Ohio)
Health care is free and It works in Europe, Canada etc because they regulate everything to prevent people from getting. Not doing so would make the system go broke. They ban GMO's, agribusiness ( livestock living in cages fed hormones, antibiotics, steroids etc) pesticides, chemicals, water, air pollution, etc,for they cause huge # of health problems. In the USA, BIG business, agribusiness, big pharma, malpractice lawyers would lose. If the government regulates, docs would have less sick people to treat, and hospitals wouldn't be packed. Insurance companies would DISAPPEAR and malpractice lawyers would be obsolete. , THIS is why the USA opposes OBAMACARE. Simple!
G.Kaplan, MD (Cleveland, Ohio)
by now we conclude Trump is an unstable sociopath.
In the AM he says something and by PM he changes his mind. Imagine if he was in charge of the RED NUCLEAR BUTTON. How do we trust him?
Scott Everson, RN (Madrid)
The GOP front-runner one time at least endorsed/admired a single-payer system. To me this is revolutionary. Will the media ever give him credit for this? How people fear Trump when the alternative is Cruz astonishes me.
G.Kaplan, MD (Cleveland, Ohio)
The only system that works is what Romney = Obama are working on

It works in Europe, Canada etc.. Opposition to same is because the government regulates in order to keep its people healthy to prevent going broke. For example GMO's, agribusiness ( livestock living in cages fed hormones, antibiotics, steroids etc) pesticides, chemicals, etc, all this cause disease, so they have regulators. BIg agribusiness, big pharma, insurance companies, malpractice lawyers would lose. doctors would have less sick people to treat, so hospitals wouldn't be filled, and insurance companies would DISAPPEAR. , THIS is why the US opposes OBAMACARE. Simple!
P. MB (France)
Maureen (California)
When any Republican talks about health care reform all they really have to say is "repeal the Affordable Care Act and once we do that we'll figure out something to replace it, I promise." The reality is that any feasible reform involves working within the framework already established by the ACA and utilizing the government's "buying power" to negotiate reduction of costs, particularly medications, imaging technology, and medical devices in common use. We can do this. Private companies, such as Walmart, are already doing so. If Republican's want to really score points, then let them emphasize their willingness to lean heavily on our pharmaceutical industry and opening our programs to imported medication. After all, Mr Trump and his fellow travelers have made much of their abilities as business people experienced in the art of the deal. If we changed nothing more, the positive impact on the cost of our medical care and the health of our citizens would be enormous. Transferring non-geriatric patients with pre-existing conditions to Medicaid rather than keeping them in the private market would also reduce costs and increase access to care. The "fixes" are not rocket science, but they require two things of Republicans that fall outside of their conservative orthodoxy: working within the existing ADC framework and reducing the excess profitability of both the pharmaceutical and insurance industries.
Paul King (USA)
"...but there’s a huge gulf between that rhetoric and the practical consequences of his policies."

That says it all about Trump and general conservative dogma passing as realty.

It's a facade folks. Because real action that does something concrete for Americans usually requires some level of government action and a plan and, yes, spending on an actual program. Not just the usual conservative laissez-faire tax cuts for (pick it) and reliance on "church groups" or other nonsense they spout. Been hearing it for decades.
(they even opposed government intervention during the great depression in the 1930's! Nuff said.)

Conservatives, especially today's virulent breed, are pretty much incapable of allowing for any government action or involvement in anything - even when clear benefits to the nation are possible.

So, the gulf between reality and rhetoric is no surprise.
That Americans still fall for it is amazing.

Now, ask yourself, are you a Trump Chump?
Fred (Dewitt)
Health Care is a product every person wants, some people feel is is a right of all. Folks who are sick and need the best feel they are entitled. But no one wants to pay for it. The one issue no Republican President is going to want is for Congress to send a bill to the White House repealing the AHCA with out a suitable replacement. It would be disaster.
Wcdessert Girl (Queens, NY)
Healthcare reform is not easy and chanting "single payer system" over and over again at the top of your lungs will do nothing but give you laryngitis, which will you will have to treat in the current crappy health care system. The fact is the profit based insurance and pharmaceutical industries are way too powerful. How did we become a country where profiting off of the pain and suffering of people became an acceptable business model? Easy. Because it pays so well. And why is it that for all of the people who want government operated healthcare like in the UK and Canada, or a single payer system, do we keep getting further and further away from those possibilities? Easy. Because helping people because its the right thing to do, will benefit us all in the long run, but will harm the bottom line of the profiteers, who own most of our elected officials.
Any presidential candidate can say whatever they want about health care reform.True reform starts in Congress, where the laws that have allowed big pharma and the insurance industry to place profits before public health are passed and any attempt to curtail their power and level the playing field is dead before it hits the floor for a vote.
Janis (Ridgewood, NJ)
No candidate can truly answer this question of healthcare reform until they are in the position and specifically know what they are dealing with. Pharmaceutical companies and device companies must concede to negotiations and a tremendous amount of money will be released. A single payer system is unaffordable unless people want to hand over 70% of their payroll deductions to the government. Obamacare in its presents form does not work. Some people cannot afford the premiums ad I hear this constantly from people when the child turns 27 and is off of their parents plan. So get realistic.
ExPatMX (Ajijic, Jalisco Mexico)
"When the child turns 27"? In what alternate reality is a 27 year old considered a child? The extended time was to allow people to get an education. It was never intended to cover all adults.
Avarren (Oakland)
ExPatMX - In the reality that no matter what my age is, I'm still my parents' child. That's how genealogy works. And yes, I'm an adult by the age definition and I have my own health insurance.
Dean (West)
The only way to solve the disaster that is the $3T health care industry is with nationalized health care. What are we waiting for? Do we wish to continue spending double what other first world countries spend for average or below average results? Capitalists should consider this a bad situation. It is very inefficient and a drag on the economy.

Can we lose the learned helplessness and fight for what we want until we get it? What happens to those people, currently with guaranteed coverage under Obamacare, if the ACA is somehow repealed? I don't care if corporate hospital chains have to revert to reducing costs or return to 'charity' care if the insurance payments are no longer made but individuals are a different issue.

At any rate, the problem with Trump is that he changes his mind on a whim and sometimes within hours. Who knows what he actually thinks about anything or if he thinks much at all.
Kevin Hill (Miami)
Analyzing Donald Trump's fever-dream "policy proposals" has to be the worst assignment an editor can give to a journalist.
Scott Cole (Ashland, OR)
The single-payer system will NEVER come to pass in the US. The insurance industry is too intertwined in the economy and political system, and only an extreme congress would propose to wipe out a multi-billion-dollar industry.

There are several things I would like to see improved in the current system:
1. Get rid of networks, which discourage competition. When my own insurance premium jumped by a third recently, I could not sign up for the only competing plan because my doctor wasn't on the network. We should be able to go to ANY doctor ANYWHERE with one plan.

2. Eliminate the differences between medical, dental, and vision. If you have a severe dental issue and need a root canal or have an abscess, why should you need a different type of plan? It's your body, period, and should be covered. And the costs for dental or vision work should apply to your medical deductible.
Vision plans now encourage waste.

3. Eliminate the interstate barriers. Insurance can still be regulated, but we need more competition. My car insurance is with a national company, and my musical instrument insurance is from across the country. Conservatives should be arguing for more, not less, competition.

4. Eliminate employer-based insurance. Let ALL workers shop for insurance, including government employees and members of congress. Cadillac plans are either under-utilized by the young and healthy or encourage high charges from providers.
sssilberstein (nevada)
Original Medicare provides health insurance benefits across state lines. So the solution to this shortfall would be to allow everyone, at any age, the freedom, if so desired, to sign up for Original Medicare. While a universal single-payer system might be a hurdle to high to cross, voluntary enrollment to Medicare would be a step in the right direction. It would provide lowered premiums and deductibles for beneficiaries, thereby increasing easier less costly access to health insurance, with great benefits. And it would provide increased revenue and lowered claim ratios for Medicare, thereby lowering the net cost of medical care, vastly extending the period to any breakeven point when claims reach revenue amounts. It would also be a seamless, easy, uncomplicated transition to enroll.
Louis A. Carliner (Cape Coral, FL)
The only health insurance scheme that would cross state lines that should be allowed are single payer systems like Medicare! Otherwise, any private health insurance that would be allowed to cross state lines would end up being just like what happened with consumer credit card products: a nasty race to the bottom, with most consumer protection from extortionately high interest rates and fees! A major flaw in high deductible products would leave mothers with children born with serious birth defects, like zita virus brain size defects bereft of any help from a lifetime of budget draining medical expenses! How many women faced with such horrors would be tempted to go the abortion route!
Jeffrey B. (Greer, SC)
There is a word to describe a leader, or the leadership, that wishes to march us backwards, and Mr. Trump seems to fit the bill. I am not a fan of Obama-Care, but I am a fan of helping those who cannot help themselves in a Wealth-based healthcare system. The hyperbole ---"People dying in the streets"--- aside, I try to remember that we are all enriched when we help each other, and, to coin a slogan, a healthy nation is happy nation. (Corny, huh?)
Oh, that word? Atavism, possibly? Where that activity goes I don't want to.
Nice job, NYT-Upshot.
MLS (Jackson, NJ)
"He may describe himself as more compassionate and generous on health care than his rivals, but there’s a huge gulf between that rhetoric and the practical consequences of his policies."

Trump in a nutshell. He says one thing and there is no truth or he means something else. The World is laughing at us!
paul (blyn)
Other than the drug thing Trump's version looks like the old GOP de facto criminal version of be rich or don't have a bad life event.

He has changed he mind over the yrs., now he has endorsed the GOP's de facto criminal plan....tax cuts?...a poor person pays very little income tax, what is a few thousands tax credits gonna do to help a 20k policy?

What we end up is rich people getting better plans than ever and poor people getting witch doctor plans..... The republican way.

We have a cultural abuse sickness in this country re medical unlike our peer countries. Republicans refuse to get out of their bunker to do something about it.
AO (JC NJ)
more republican slight of hand and gibberish.
Bernard Shaw (Greenwich, NY)
this is not his plan. and the elements shown are totally bogus and will accomplish nothing good in reducing prices it is all smoke and mirrors and will deny millions the protection of pre existing conditions. Having emergency care does not work. People are forced into bankruptcy by this process.
dre (NYC)
Like most everything the repubs put forward, Trump's plan makes no sense.

Only single payer makes sense.

Trump's is a modified version of what we've had since the 1950s. It has never worked for those that didn't have good coverage through an employer, and those plans are disappearing.

Most jobs today have few if any real medical or other benefits. Nothing the party of the 1% proposes makes sense for average people. They're insane.
Gloria (Brooklyn, NY)
The same goes for Clinton. Only single payer is the answer.
Jane Taras Carlson (Story, WY)
Precisely what sort of health care provisions would work fairly for the whole country, other than socialized medicine, which I support?
Vince (New Jersey)
I cannot wait until the Republicans finally decide on a nominee. Because even if it isn't Trump, the Republican nominee will have to somehow justify in front of millions of Americans on national TV while debating Sanders/Clinton taking away insurance coverage from millions of Americans. The dearth of ideas coming from the GOP is just staggering. As Christopher Hitchens said about the 2008 election, it has become morally and intellectually impossible to vote Republican. If only he were alive today to witness the GOP's decline since then.
JMM (Dallas)
I did hear Trump say during Super Tuesday's victory press conference when he announced the details of his plan that the insurance companies would have to allow pre-existing conditions. I breathed a sigh of relief.
kathyinct (fairfield CT)
WHY??? As usual, he lied.

He said he'd protect us -- then his actual plan says repeal Obamacare, including protection for preexisting condition.

Sucker.

This is is habit. Say one thing, wink wink, and then do something else.

Refuse to disavow KKK, wait a few days so they get his "wink, wink" message, then say OK, just kidding.

Hey, dumb sick people, I'll protect you. You are relieved. Then, wink wink to right wing, his plan emerges. Too bad, sick people.

The man is a congenital, habitual, pathologic liar.

Get used to it.
SMB (Savannah)
This is scary, like most of Trump's policies and those of his Republican opponents. Getting rid of the ACA throws more than 20 million Americans back into the no man's land of no insurance. Medical bankruptcies have been due to the lack of insurance for preexisting conditions which insurance companies can define to include being a woman or other broad categories. Young people would lose their insurance who are now covered by their parent's insurance until age 26.

People would die. People would suffer. Interesting what Trump regards as a "great" America.
Nuschler (Cambridge)
Yes, let's talk about bankruptcies due to medical bills.

"Bankruptcies resulting from unpaid medical bills will affect nearly 2 million people this year—making health care the No. 1 cause of such filings, and outpacing bankruptcies due to credit-card bills or unpaid mortgages, according to new data.
AND even having health insurance doesn't buffer consumers against financial hardship."

CNBC 2014.

Because of having to work with health insurance companies some families have a $5,000 deductible to pay even before they can get needed surgery or treatment.

Health Insurance Companies had WAY too much pull in the design of the ACA. As a health care provider I see every day how folks didn't get Medicaid expansion because GOP governors REFUSED federal monies. I see patients suffer as they can't afford the deductible. I volunteer my time in the clinic and convinced a 40 y/o private business owner to buy Obamacare. She needed surgery but didn't have the deductible. I felt so bad that I gave her the $1500.

I'm 67 y/o and on a fixed income...I can't do this again. It HURTS to see my patients hurt! I so HATE the GOP. They might as well wear NASCAR jump suits with the names of the companies embroidered on patches on them. Then we can see EXACTLY which corporations OWN them.
William Baumann (NY)
Romney and McCain are as I recall are two losers. They could not come up with a health care plan, which is the most important concern for Americans, staying alive without going bankrupt. Let Trump have a go for it if the People are voting for him. Why the Panic from the Republican Establishment? The grey-haired men have had eight years to come up with an un-Obama Care. But they really don't care. The People are voting for Trump. Even Rick Scott in Florida says let the People decide.
Gemma (Austin, TX)
The "People" you describe are the pick-up truck driving, ignorant masses, who don't believe in reality, refuse to educate themselves by reading FACTS, and clearly engage in magical thinking, imagining that a reality star who lies to them and tells them what they want to hear can be their savior. It's pathetic. At present those people are simply a vocal MINORITY. And if the rest of the people don't get out and vote, they will decide the fate of this country. It is truly SCARY.
Jane Mars (Stockton, Calif.)
"People" as in "the People" isn't capitalized in English...though I believe it is in German.
Susan (Piedmont, CA)
Please! Cut the contempt. Because a person drives a pick-up truck does not make him or her inferior to you. This comment makes me wish Trump wins.
Robert (South Carolina)
Whatever he says, it will benefit him.
kathyinct (fairfield CT)
Trump Caskets.

for people who died without healthcare.
FH (Boston)
If you don't have the mandate for individual coverage it is impossible to avoid adverse selection. Also, I'm not sure that allowing insurance to be sold across state lines has anything to do with states' rights, as long as the carriers comply with regulations in each state in which they wish to compete. Lump sums to states for Medicaid increases the likelihood that state governments will find a way to use that money for something else and dress it up as "healthcare." Nonetheless, at least Trump offers a plan...which is something the Republican Party has not been able to do for the past 8 years.
Dunmore Throop (Lower East Side)
The important take away from this is: full of holes and logical gaps as it is, Trump STILL has more of a health care plan than any of the other Republicans, or the Party in general, even after all these years. To pretend for one second that the Republican 'establishment' is more responsible, wise or honest than Trump is totally unjustified. Romney, et al have run on nothing but lies and misinformation... Going back at least since 2008 but really since a couple decades before that. Trump is winning because as bad as he is he is actually BETTER and more honest than them, horrifying and pathetic as that fact is.
David Henry (Walden)
We have lost sight of the original sin. The GOP has no problem with running on the joy of depriving millions of health care.

Think of it: a sick fellow American hasn't a right to see a doctor. Welcome to Lincoln's party.
lgalb (Albany)
I'll be surprised if some Republican does not accuse him of plagiarism. Trump's main points are exactly what the party has been stating the last 6 years.
B (Minneapolis)
Donald Trump's "health coverage proposal" cuts off all three legs of the stool upon which health reform is based - the mandate, subsidies and exclusion of pre-existing conditions. Without these three features insurers will act as they did before Obamacare , denying coverage to the sick and poor. Great job Brownie!
Tom (Midwest)
The problem is Mr. Trump's plan won't work. Insurance across state lines? Trampling on state's rights. Repeal Obamacare? Been tried 60 times and lost in court. Block grants to Medicaid? Pity the poor in red states who have already seen what republicans do to medicaid programs. Import drugs? a permanent employment program for lobbyists of drug companies.
dundeemundee (Eaglewood)
I wouldn't necessarily say that Trump's health insurance plan is typical Republican. In fact in one respect it is very innovative.

Getting rid of the regulations that make it hard for health insurance companies to cross state lines, would do more to lower health costs than anything combined. Doing this would put a lot of the smaller insurance firms which are special interests protected by their individual states, while encouraging the growth of mega national and international discount vendors.

Saying that this is the same as what Rubio and Cruz and the rest of the Republican establishment wants is incredibly disingenuous. In the first Republican debate when Trump said he was going to do this he was booed. There are too many wealth Republican voters who feed at this protectionist trough, free interstate insurance trad would impoverish core primary voters and donors.

And doing away with state restrictions on health insurance is not something the Democrats could do either, because Obamacare was constructed and beholden to by granting unheard of power to insurance and big pharma.
Phil Dauber (Alameda, California)
Repealing Obamacare and removing restrictions on health insurance across state lines would create a Wild West situation even worse than what we had before ACA because effective regulation at the state level would no longer exist. Strong federal regulation would be needed, but that would mean restoring part of Obamacare and/or enacting even stronger federal regulations. Republicans in congress would never agree. They are beholden to the insurance industry even if Trump isn't. What is Trump going to do, pay for all their election campaigns? As usual, Trump's proposal is a fraud, and anything but innovative as republicans have proposed this deceptive maneuver for years.
Purplepatriot (Denver)
At least Trump has a plan, as half-baked as it may be. That's more than the rest of the GOP has. Unless they intend to revoke the insurance of 20 million Americans, I don't think the republicans are going to change anything in the ACA. They just like to use it to arouse the rabble.
Annie Dooley (Georgia)
Yes, it does sound like the same old same old Republican ideas, but at least he has put something on the table and is willing to take on Big Pharma. I'll give him credit for that. The other GOP candidates are hiding. Bernie Sanders is the only candidate with the "tell it like it is" courage to declare that single-payer is the only sensible, affordable way to provide healthcare for all. Time to stop trying to appease the profiteers in the medical "industry" and start birthing healthy babies, healing sick people and saving lives at the lowest possible cost.
Phil Dauber (Alameda, California)
Sen. Sanders is wrong when he says single payer is the only "sensible, affordable" way to provide healthcare. Not only that, he knows he's wrong. Various countries in Europe, notable Europe's largest country, Germany, have multipayer systems that deliver excellent healthcare at much lower cost than our system. Insurance companies are part of the mix, as they would be even in Sanders' "Medicare for All." The difference is that effective systems have strong regulation of costs at both the insurer and the provider level. Sanders doesn't want to talk about this because it would set the whole medical industry against him, especially doctors.
Sohio (Miami)
For his sake, I hope his health care plan covers hair. He definitely needs SOMETHING to cure whatever that thing is on his head.
Ian MacFarlane (Philadelphia PA)
Universal health care for all without restriction carries more appeal than a military with enough weaponry to kill every form of life on earth.
hr (nyc)
What a ludicrous health plan Trump exposes! Thanks for explaining Trump's non-plan, and shedding some light on the even more non-existent plans of the other wannabe Republican candidates. Luckily, Hillary is amazing on health-care, and although she was prevented from implementing her plans when she was First Lady and as senator, and has been repeatedly savaged by violent and sexist Republicans, Obamacare. as you point out, has given access to health-care to fourteen million Americans so far!
laurence broadus (fort washington,maryland)
Twenty Million---20,000,000, I don't think the" Splinter" group want to do that--20,000,000 million people that has health insurance because of two term (who won by over 5,000,000 votes) President Obama
SMB (Savannah)
One thing was salvaged from Hillary Clinton's initial health care plan back when she was First Lady -- CHIPS that covers low income children. That has saved millions across the years.
mj (<br/>)
My takeaway?

Someone in the Pharma industry made him mad and he wants to get even.
David (Austin TX)
As someone with leukemia, the pre-existing clause is essential for all of us with complex and even less complex and complicated illnesses. I cannot image what my life would be like if we return to older models of insurance that allow health insurance companies to deny coverage to us. This would be devastating and we cannot allow the Republican Party to change this.
Banty AcidJazz (Upstate New York)
Most of all, his plan does not address the connection between requiring coverage of pre-existing conditions, and the individual mandate, that he was having so much problem with, in the last debate.

His across-state-lines statement alludes to state standards, but is not clear on whether or not this is the state being sold into, or the state being sold from. In other words, will it prevent a race to the bottom.
Carl Hultberg (New Hampshire)
It will be Obamacare, but totally improved by being called Trumpcare.
David Henry (Walden)
No, it will be NO CARE. period. Now is not the time for irony or wit. Just reality.
HANK (Newark, DE)
Everyone will need medical intervention at some point in life. If single payer is DOA, the only alternative is an individual or someone on their behalf starts paying for it the moment the birthing process is over.
mj (<br/>)
sort of like College. So now when you have a child you'll have to start a college fund and a healthcare fund.

Want to guess how many people will never have either?
An iconoclast (Oregon)
If this contest gets any closer to being the complete joke that many are sensing we'l all need a medical intervention except those needing a hearse.
John Smithson (California)
Donald Trump is against the individual mandate to buy health insurance. That puts him in the same camp as Barack Obama. Does no one remember that Barack Obama campaigned against the individual mandate in 2008? He said that it was unfair and the wrong approach to force people to buy a product they didn't want.

Funny how what goes around, comes around.
Banty AcidJazz (Upstate New York)
Then, if you don't recall, he championed a plan that was more realistic in that regard.

Digging back to what his debate statements were, serves no purpose other than a partisan one. Clinton was right on that point; when Obama engaged more with the problem, he understood the issue better.

This is a so-what.
Purplepatriot (Denver)
That's when the single-payer option was still alive. Obama realized single-payer was a political impossibility given the financial influence of the big insurers. Without their buy in, reform was a non-starter.
mj (<br/>)
And how clever of Mr. Obama to figure out that would never work. Our President never ceases to impress with his thoughtfulness and intelligence.
Nuschler (Cambridge)
“Though the pharmaceutical industry is in the private sector, drug companies provide a public service,” the document says. Just what sort of public involvement he’d champion is unclear. The plan says he would favor importation of foreign drugs, an interesting departure from his usual trade policies.

1) Big Pharma provides a public service?? Pharmaceutical companies provide big dividends to their shareholders. Period! The poster boy for “public service” is Martin Shkreli! Until we have universal coverage by the government we are all at the mercy of whatever the drug industry wants to charge. Increase a tablet needed to survive that WAS $7.50 they can now charge $300/tablet.
Brand name drug patent expiring? Just add a hydroxyl radical and it becomes a NEW drug that can’t be copied for another 10-15 years. Re-name it. The radical doesn’t change the efficacy of the drug or decrease side effects. It does allow the drug company to keep charging high prices and NOT allow generic copies.

2) Import foreign drugs? Without going through our stringent FDA screening? The USA has the toughest, longest approval trials in the world. I think back to Thalidomide---a drug “safe” for first trimester insomnia. It got the OK in Great Britain. They now have a generation of folks without limbs.

http://www.sciencemuseum.org.uk/broughttolife/themes/controversies/thali...

Trump’s ideas are as bizarre as he is! Did he think this up on his own? Or over a club soda with Pfizer rep?
Ender (TX)
Wow, do we really expect to get a realistic proposal for health care from anyone running as a R? Cutting taxes for rich people? Now you're talking.
Peter (Seattle)
You forgot the most important thing. Trump’s plan, does away with insurance mandate. This is one issue that seems to bother people the most. The rationale is that we should not be forced to pay insurance if we do not want to.
That is all nice and fine, but what is left out of that debate is that without individual mandate, you have to have pre-existing condition and you have to have life-time caps. Otherwise, who in their right mind would buy insurance before they get sick?
The cost of modern healthcare is so high, that if anyone needs a more serious intervention (cancer treatment, major surgery, etc.), it would take almost a lifetime of premiums to pay for that. This is the rationale for everyone having to have insurance. I dare anyone to present a plan without a mandate, that will work as ACA does today.
Ralph (St. Louis)
Well said Peter!

The 'insurance' concept only works when more are paying in than taking out. And the reality of modern healthcare (even once you strip away the excesses) is that the mechanisms to maintain and extend our lives simply cost more than we are paying in. We have to stop thinking of this as insurance that a person can naively believe they have no use for.
Purplepatriot (Denver)
People who choose not to buy insurance are selfish. They don't want to pull their own weight because they know the rest of society will probably pay the bills if they get sick. That was the old status quo. The ACA has made great progress in convincing people to take responsibility for their own health. Of course, many will remain unreachable and irresponsible no matter what we do.
HT (Ohio)
Yes. Life time payments are "prepayments" on health insurance, spreading the cost out over a lifetime.