Feel Like A Million

If Trump Were Brilliant

I was reading Kevin Drum's #1 rated blog this morning, and got to thinking about his take on ObamaCare.

Drum argues that everything about the Affordable Care Act is popular--with Democrats, Independents and even Republicans, except of course for the Individual Mandate that requires everyone to have insurance.  But what if that one exception could be given a Trumpian spin, such that everything else is left alone.  If that were possible, everyone wins.  Trump is the unifier;  Republicans go along to avoid the ineluctable contradictions of "replacing" ObamaCare; Democrats are willing to let Trump bag a gob of glory if their vision is preserved; and a B program is upgraded to B+.

And how could that be possible?  Everyone knows that one of the ineluctable contradictions of replacing ObamaCare is that once you remove the Individual Mandate, the pool of insured people in any particular plan skews sicker and sicker, as costs rise and healthier customers exit.   If you're one of the last 25- or 35 -year-olds to have insurance in a plan, premiums will likely have already doubled, tripled or quadrupled, and can be expected to rise even further, meaning you can't afford insurance, even if you still wanted it.

Feel Like A Million?
But what if we simply sweeten the recipe with an outlandish, Trumpian gesture?  What if all those angry young men who resent being forced to buy something they sense they don't need had a self-interested reason to buy it, even if they only did so grudgingly?

Ah, you say, but what do young people really want?  Cash.  What if Trump proposed that a contest be run to encourage a healthy citizenry.  Winners would receive a million dollars--thus the slogan, Feel Like A Million.  Each congressional district would have ten winners a year, drawn randomly from among those who had insurance.  436 x 1,000,000 x 10 = $4.36 billion.

But how is this a contest, rather than a lottery?  Winners would be guaranteed $100,000.  To get the full $1,000,000, winners would have to have visited their doctor at least once over the past year, and discussed various preventive healthcare options like vaccinations, cancer screening, smoking cessation, etc.  They wouldn't have to do anything, just have a talk with their doctor about their health and how they might improve it.  A winner's insurer would of course be paying for the preventive care, and thus have a record of it taking place, which would trigger the larger payout should that individual's name be chosen.

You may not like the money-for-nothing, Trumpian feel here.  And research is skeptical as to whether preventive medicine really does pay for itself.  But does any of that matter?  Remember, everyone wins.  Even the cost of up to $3-4 billion (not the full 4.36, since some winners would've skipped the doctor visit, and could only claim $100,000), would likely pay for itself.  How?  Because those being attracted to health insurance in 2018 won't be the sick; they've already signed up.  It would be the young people who feel so healthy that they pay the tax penalty for not having insurance.  And the more that healthy people sign up, the less insurers need charge in order to break even; and, yes, insurers are limited in the percentage of revenue they can keep for profits, overhead, etc., so that $3-4 billion would likely pay for itself with generally lower premiums the following year.