Obama's health care mess is now Trump's

My friend Patrick Spain, a serial internet entrepreneur, now runs a tele-medicine company called First Stop Health to which I subscribe. In other words, all of the flus, backaches, rashes, passing infections, and 24-hour viruses, the stuff of most doctor visits, are, in my house, handled by a telephone call. Call a number, describe your symptoms to a  nurse, then a few minutes later a doctor with the appropriate background calls you back. He asks a few follow-up questions, determines if your issue is critical or, as most are, run of the mill, and, if appropriate, prescribes medication. More convenient than making an appointment and going to the doctor, and, so far, in my experience, as effective. And much, much cheaper.

This could-not-be-more-simple approach manages to do the two the things Obamacare promised, but then failed, to do: lowers costs and makes medical care more accessible. This failure helped open the way for Donald Trump’s election. And now Trump, like Obama, is poised to get messed up over health care, too.

If Obama went in one direction, essentially raising the costs and reducing the benefits of those who had insurance to help subsidize the costs of those who didn’t, Trump proposes to go in the other. He’ll water down the benefits that have been extended to a broader population in the hopes this will somehow restore a system that, by pretty much every estimate, is never going to be put back together again.

As Obama felt he was going to be the savior by succeeding where no once else had of overhauling a health care system, Trump now feels he’ll be the savior by undoing the overhaul that made few, if anyone, happy.

Each side is firmly grounded in its ideological point of view, with goals that are at least as much symbolic, not to mention grandiose, as they are functional. Of all the many things that Obama clearly seemed to lose sight of in his drive for historic legislation, one was certainly the consumer experience. Trump with equal ideological passion and historic ambition is as likely to back himself into an overhaul more suited to pleasing politicians than to pleasing patients.

On the other hand, health care could actually be one of those areas ideally suited to Trump’s sense of how to spiff things up for a quicker sale. In other words, you get a better return by fixing up the lobby and putting some new siding on the building than knock it down and building again.

The stakes are actually extraordinary: the least dent you make in the $3 trillion a year U.S. health care bill, or even in its growth trajectory, would rebound through the American economy; any sense you can engender in voters that their health care experience has improved might create the kind of loyalty that sustains political parties for generations.

Radical overhaul, on the other hand, with its disruption, uncertainty, and inevitably unintended consequences almost certainly does the opposite of that.

At the moment, it would appear that repeal and replacement of the Affordable Care Act will be radical overhaul. We can look forward, beyond likely additional costs, to a world in which there is unstoppable and incomprehensible proliferation of insurance policy options, at ten or a hundred times greater than the already stultifying choices under ACA. And, count on it, each of those policies will require supplemental policies, for which there will be an endless choice and for which you will have to be able to predict the manner in which you will likely be sick in the future. The Republicans, by every indication, will make health care at least as complicated and opaque as the Democrats.

Indeed, among the many arguments against the Affordable Care Act is that its massive bureaucratic restructuring and vast regulatory complications impeded the kinds of market innovations that might make health care cheaper and more accessible. That’s part of its ideological conceit: health care is too important for the market. But curiously, the free market Republicans, seem no less willing to create top-down controls on health care, with solutions that are merely alternative bureaucratic solutions.

Still, there is a sense, that Trump might just be an old fashioned sort of politician who wants to keep people happy. In health care, that means make it simpler, make it more convenient, make it cheaper, make it more available.

I’d argue the merits of my tele-doctor. Not only is the convenience great, and my disembodied doctors knowledgeable and friendly, but there are 1.2 billion annual physician visits in the U.S. each year, and roughly half of them don’t require a physical exam. An average visit costs $170, an average tele-doctor call is $55.

It is an early indicator for Trump. Is he messianic in his ambitions, wanting to replace Democratic superstructures with superstructures of his own? Or, like the good salesman he has always been, would he prefer to sell people things they want to buy?