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In a stump speech full of hyperbole, mistakes and pants-on-fire lies, Donald Trump routinely blasts Obamacare (the Affordable Care Act) as a complete disaster, a trainwreck, and a total failure. He lists no specifics but only generalities, claiming he will replace every bit of Obamacare with something “terrific.” But he won’t say what his replacement plan is, other than it will provide broader coverage to more people at less cost than the present law.

In his rant against the present act ignores all of the evidence that it is working as planned – bringing affordable insurance to millions, allowing people to change jobs without losing their insurance to pre-existing condition exclusions, relieving the unfortunate who have encountered catastrophic health situations from worry over caps and limits of coverage, and providing assurance to most of us who obtain coverage through their workplaces by eliminating the risk of sudden cancellations, and guaranteeing consistency, certainty, reliability and permanency.

In countless ways, the ACA has made the health insurance coverage that is presently available from private carriers financially safer, more certain, less arbitrary, and more reliable, with better claims procedures, more resources allocated to claims, and better and more consistent processes for the adjudication of disputes than ever before.

Trump also ignores that fact that the ACA is fundamentally a Republican program – hatched from research by the Heritage Foundation created for Nixon in the 1970’s, and formed after the Massachusetts plan sponsored by Mitt Romney during his term as governor there. It has worked successfully in Massachusetts ever since – a point that Romney completely tried to ignore during the 2012 campaigns, and the Republicans continue to ignore to this day.

The only specific aspect of the ACA that Trump points to as indicative of its failure is the rising costs of current coverage, in terms of higher premiums, higher deductibles and higher co-pay. However, Trump fails to recognize that costs and premiums have gone up less under the ACA than they were predicted to increase without the ACA. More important, Trump ignores the fact that the federal law has nothing to do with the premiums, deductibles or co-pays under any of the private insurance plans being offered.

Even here, Trump badly exaggerates the situation, claiming insurance premiums have skyrocketed by almost 50%. While there are a few pockets with significant increases, the overall average increase in premiums has been under 7.5% per annum – which is high, given our low inflation rate, but nowhere near the disaster Trump predicts, and less than economists predicted for insurance premiums before the ACA was enacted

Trumps’ tactics are proving to be an interesting campaign device, because all this is irrelevant if Trump should deliver on his plan – to replace Obamacare with something better. He won’t talk specifics, but the only plan out there that has ever been presented that will provide broader coverage to more people at less cost is single payer, government administered, tax financed, universal health insurance in the manner of Medicare for all – which Donald Trump advocated at one time, which is a keystone of Bernie Sanders’ campaign, and which is exactly what is presently offered by every other country in the industrialized world.

Bring it on!

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