Just gonna make America great again here

So here is a heck of a not very surprising surprise: In focus groups of Trump voters held in Rust Belt states, the Kaiser Foundation found that while Trump voters mostly said they didn't like Obamacare -- especially not the first three syllables of it -- they also really don't like any of the main Republican ideas being floated to replace the Affordable Care Act. There were six groups; three of Trump voters who had insurance through the exchanges, and three consisting of Trump voters on Medicaid (yeah, let that sink in a moment before you read the quote coming up here).

Though the participants did not agree on everything, they expressed remarkably similar opinions on many health care questions. They were not, by and large, angry about their health care; they were simply afraid they will be unable to afford coverage for themselves and their families. They trusted Mr. Trump to do the right thing but were quick to say that they didn’t really know what he would do, and were worried about what would come next.

The Trump voters were worried about the things that everybody doesn't like about all health insurance ever: "rising premiums, deductibles, copays, and drug costs," and they were especially bothered by one of the fun schemes the medical-industrial complex has come up with to enhance revenue, surprise "balance billing" for out-of-network costs for services or providers they thought would be covered (an innovation Trump's appointee to head HHS wants to expand to Medicare, yay).

Not surprisingly, people with private insurance on the exchanges, including people with premium subsidies, "saw Medicaid as a much better deal than their insurance and were resentful that people with incomes lower than theirs could get it." The piece didn't say for sure whether that meant they wished they could get in on that sweet deal or if they wanted all those other people to be kicked off; let's assume probably both simultaneously, since I worked hard and earned my government benefits, while those other people are lazy takers whose government benefits are a handout.

Also, the folks in the focus groups "expressed animosity for drug and insurance companies, and sounded as much like Bernie Sanders supporters as Trump voters." That cinches it! BERNIE WOULD HAVE BEAT TRUMP!!!!! (No. We did that thread already, stop it.) All in all, these folks don't sound like they're all that excited about the wonders of the marketplace, which tells us if you want your prescription, you'd better have the means to pay for it, or you're a loser.

Now, here's the not-surprise: nervous and unhappy though they are with the ACA, the Trump voters really don't like most of the ideas being floated by Republicans as a replacement:

But asked about policies found in several Republican plans to replace the Affordable Care Act — including a tax credit to help defray the cost of premiums, a tax-preferred savings account and a large deductible typical of catastrophic coverage — several of these Trump voters recoiled, calling such proposals “not insurance at all.” One of those plans has been proposed by Representative Tom Price, Mr. Trump’s nominee to be secretary of Health and Human Services. These voters said they did not understand health savings accounts and displayed skepticism about the concept. When told Mr. Trump might embrace a plan that included these elements, and particularly very high deductibles, they expressed disbelief. They were also worried about what they called “chaos” if there was a gap between repealing and replacing Obamacare.

Yeah, there's a shocker. Still, at least Trump showed that bitch Hillary what real Americans want -- they want a cabinet full of billionaires who understand ordinary people's concerns. Needless to say, Trump voters are already masters of denial, just like their candidate: Even though some godawful mix of those measures is virtually guaranteed to become part of the Rs' replacement for Obamacare (if there is one), most folks in the focus group didn't believe, as one put it, that "a smart businessman like Trump would let that happen." After all, he's a smart businessman!

The Trump voters did pine for one aspect of the insurance system before Obamacare: the ability to buy low-cost insurance plans that didn't cover a hell of a lot, but had low monthly premiums, even if that meant that people with health problems had to pay more. These folks really don't leave you with the impression they actually "get" insurance in the first place:

They were unmoved by the principle of risk-sharing, and trusted that Mr. Trump would find a way to protect people with pre-existing medical conditions without a mandate, which most viewed as “un-American.”

We would like all the benefits of insurance please, without having to pay for it ourselves. If the sick can't afford coverage, that's their lookout. If we get sick, we should not be penalized for it, because how is that even fair? Then they all drove home in the cars that they were mandated by the government to have liability insurance on.

So what would the ideal health insurance system look like to the Trump voters?

If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs. It would also address consumer issues many had complained about loudly, including eliminating surprise medical bills for out-of-network care, assuring the adequacy of provider networks and making their insurance much more understandable.

Oh, and they wouldn't want to have to pay for insurance until they need it, and then pay very little, because they have exactly the sophisticated understanding of economics as the guy who builds beautiful buildings and then skips out on the bills.

Sadly, Trump voters aren't likely to get their perfect system, which for some reason reminds us a bit of Homer's Dream Car, which they would like very much to have all the cool stuff but only cost as much as a Hyundai. And they're highly unlikely to get it from a Trump administration:

Republican health reform plans would probably increase deductibles, not lower them. And providing the more generous subsidies for premiums and deductibles that these voters want would require higher taxes, something the Republican Congress seems disinclined to accept.

We can think of a health insurance system that actually does have low out-of-pocket costs, controlled drug prices, and universal coverage. It's pretty much how the German medical system works. But that's socialism, and would probably lead to gun control, death panels, and ultimately a communist Nazi takeover.

[NYT]