Evan Vucci/AP Photo
President Trump’s plan to distribute prescription drug discount cards was announced with great flourish at Charlotte Douglas International Airport in North Carolina on Thursday.
Donald Trump is a con artist. Not only is this a reasonable assessment of the sum total of his actions in business and politics, it’s also the considered opinion of the state of New York, extrapolating from the $25 million settlement with his fake college, Trump University. It was a scam where students were pressured into paying more and more for expert advice on investing in foreclosed properties, which led to massive credit card debt rather than successful business plans. The picture of Trump’s tax returns rendered by The New York Times extends the con, showing that he paid next to nothing in income taxes while claiming dubious losses on his real estate holdings.
Trump’s history in the White House also contains all the elements of a con, and not even a particularly thoughtful one. Yet throughout the first term, the opposition has only occasionally portrayed him in this fashion. You hear much more about how Trump is a dangerous threat to the American way of life or a puppet for Russian interests, rather than what he is: a simple grifter. If they had been hammering this description, the desperate actions Trump is taking in the weeks before the election would be seen in their proper context.
Take for example the prescription drug proposal announced with great flourish in North Carolina last week. This one makes Trump University look like Harvard. The president offered senior citizens on Medicare $200 drug coupon cards to offset their medication expenses, with no timetable for when they will arrive beyond “in the coming weeks.”
This $6.6 billion plan is derived from savings from another proposal, which would lower prices on certain drugs to an international average, that hasn’t been put in force yet, and won’t be before November 3. “The Trump administration is effectively pledging to spend $6.6 billion in savings that do not currently exist,” Stat News put it succinctly. In addition, Congress would presumably need to appropriate this phantom $6.6 billion, even if it’s authorized, as the White House insists, through a Medicare demonstration project.
The fake discount drug card announcement came in the middle of Trump’s fake health care replacement plan, which doesn’t do a whole lot more than pretend to give $200 to people and pat them on the back. The first thing to know is that the entire plan, codified in an executive order, is nonbinding. The second thing to know is that the first several thousand words of the order is a recapitulated spin on what Trump has already done on health care, policies which led to the first increases in the rate of the uninsured in a decade, even before the pandemic hit and millions more lost coverage.
If you manage to wade through that, you get to the “policy” item, which states: “It has been and will continue to be the policy of the United States … to ensure that Americans with pre-existing conditions can obtain the insurance of their choice at affordable rates.” Of course, Americans with pre-existing conditions can already obtain insurance without exclusion, under the Affordable Care Act that the White House is trying to toss out in the Supreme Court, bolstered by the right-wing nominee who will be installed just in time to hear the case.
The rest of the order is a series of vagaries about giving people “choice” and “quality” and “affordable” options in health care. There’s a riff on how the administration “shall work with Congress” on a fix to surprise billing by December 31, or else … well, or else the Health and Human Services secretary “shall take administrative action,” with no indication of what that administrative action would be. HHS Secretary Alex Azar had no details on the administrative actions in a briefing with reporters last Thursday. “Hospitals, doctors, insurance companies … had better get their act together,” was a literal quote from Azar. So the administration’s policy is, approximately, “somebody do something.”
This health care “plan” also incorporated two prior orders: a finalized rule on hospital price transparency, and a demonstration project enabling the importation of prescription drugs from Canada. The price transparency rule, which comes into effect January 1, remains under legal review after a suit from the American Hospital Association. In general, this would be a step forward, though the idea that people with serious medical conditions would price-shop for treatment in their area would be dubious even if 90 percent of metropolitan health systems weren’t highly concentrated, and therefore fairly impervious to price comparisons.
To be fair to Trump, con artistry has been how the Republican Party has operated for several decades now.
The prescription drug importation order got a boost this week when Azar formally certified that importation would be safe and cost-reducing, as required under Section 804 of the Federal Food, Drug, and Cosmetic Act. (This is in contrast to every other HHS secretary in history, including Clinton’s and Obama’s.) However, the regulation would require states to apply for participation, the planning for which could take months. Plus, if all Americans started importing drugs from Canada in any meaningful quantity, the first thing that would happen is the drugs would run out. We need to lower American drug prices, eventually, and there are actual alternatives available to any president right now, like seizing drug patents and licensing them to manufacturers who will distribute them affordably. Instead, there’s this ultimately unsatisfying solution that sounds good but offers little.
That’s a pretty good explanation of the entire health care dog and pony show last week, and of con artistry more generally. They promise the world, and later, the marks find that it’s all empty bluster. They’re parted from their money and left with nothing. As Trump is a con artist, this is of course his tactic: $200 discount cards that will never materialize, a promise for patient protections that already exist, a vow to end surprise billing that amounts to asking other people to end surprise billing.
To be fair to Trump, con artistry has been how the Republican Party has operated for several decades now. Enormous effort is spent to hide the reality of a party that exists to loosen regulations on corporations and lower taxes on the rich, and to conjure up “conservative principles” for everyone else, in substitution for decent wages or working conditions. There’s an entire industry meant to fake compassion that’s every bit an example of hucksterism as Trump. This isn’t a con artist president but a con artist political movement.
Con artistry persists because it’s hard for people to accept they’ve been duped. It’s slightly easier to at least convince a majority of it when the figurehead of the GOP is a known con artist. Joe Biden and the Democrats, eager to return to a steady state where they can sit down and bargain with Republicans, have refrained from loud proclamations of the con artistry we’re plainly dealing with. But the easiest way to fit Trumpian nonsense into a coherent box is to call it out.
