President Donald Trump made numerous false claims about healthcare in his State of the Union address. It started right at the top when he said our nation is thriving.
Can a nation be thriving when 1 in 12 people doesn’t have health insurance? According to the authoritative Census Bureau survey, the uninsured rate in 2018 (the most recent year available) stood at 8.5% or 27.5 million people, up from 7.9% or 25.6 million people just after President Barack Obama left office.
The ranks of the uninsured declined sharply during the Obama years after passage of the Affordable Care Act. That progress has been undermined by the Trump administration.
Can a nation be thriving when its infant mortality rate remains the highest in the Western world including Russia? The U.S. loses 1 out of every 172 live births within their first year of life. While that rate is falling, it is improving at a much slower rate compared with other nations.
Can a nation be thriving when its life expectancy is 2½ months below its 2014 peak? The U.S. finally broke its three-year losing streak when the Centers for Disease Control and Prevention reported last month that life expectancy edged up by a month in 2018.
But its 78.7-year average is still five years behind top-ranked Japan and Switzerland among nations in the Organisation for Economic Co-operation and Development.
Can a nation be thriving when 67,367 people died drug-related deaths, two-thirds of which are from opioid overdoses? Yes, the total fell 4.1% in 2018 from the previous year, putting an end to the upward trend.
But each year we’re still losing more people to drug-related deaths than the number who died during the decadelong war in Vietnam. The opioid epidemic is far from over.
Can a nation be thriving when somewhere between 35% and 40% of its people are obese, the most in the world? That’s 25% higher than the next highest country, which is Mexico.
None of those health issues came up in Trump’s speech. What he did talk about amounted to bragging about his nonexistent record.
Trump claimed his alternative to unaffordable insurance premiums are new plans with premiums “up to 60% less expensive—and better.” This refers to his administration’s expansion of short-term plans, which needn’t cover essential benefits; can exclude people with preexisting conditions; and can have huge deductibles and co-pays.
Less expensive? Sure, on the front end. Better? Only if you don’t get sick.
He said hospital and insurer price transparency rules, which won’t go into effect until next January, “will save families massive amounts of money.” Just 7% of out-of-pocket spending is on “shoppable services,” according to a Health Care Cost Institute study. Potential gains from transparency-driven consumer price shopping “are modest,” the study said.
Think about it. No patient in a genuine emergency will bother to read posted prices, much less say, “please take me to another hospital with lower prices.”
Next, he drew applause from Republicans when he said, “Last year, for the first time in 51 years, the cost of prescription drugs actually went down.”
That was 2018. And it was just for existing drugs, over 90% of which are generic. Last year, those prices went up 3% or nearly twice the inflation rate. And that doesn’t consider the astronomical prices being slapped on new medicines.
There is one area where there has been unmistakably good news for parts of the healthcare industry during the Trump years. Alas, it has nothing to do with public health. Insurance company profit margins tripled to 3.3% between 2016 and 2018. Hospital margins, which had dropped to 3.3% in 2016, rose to 7.7% on average in 2018.
The bottom line: The Trump years have been a raging success for the business side of healthcare. But for patients and public health? Not so much.
