Trump's "plan" is just like Paul Ryan's

It would be an exaggeration to say Donald Trump has an actual health care plan. He’s taken steps to get past his original vow to “repeal and replace” the Affordable Care Act with “something terrific,” but it’s fair to say those steps have been quite modest.

As we discussed a few weeks ago, the Trump blueprint is a weak patchwork of predictable policies – tax breaks, buying across state lines, Medicaid block grants, and health-savings accounts – that (a) seem to be the staple of every underwhelming GOP plan; and (b) would leave millions of American families behind.

The New York Times reports today that Trump’s health care ideas have “bewildered” not just reform advocates, but also Republican experts in the field.

This whipsaw of ideas [in Trump’s plan] is exasperating Republican experts on health care, who call his proposals an incoherent mishmash that could jeopardize coverage for millions of newly insured people. […]

“If you repeal the Affordable Care Act, you’ve got to have a serious way to expand coverage to replace what you have taken away,” said Gail R. Wilensky, who was the administrator of Medicare and Medicaid under President George Bush from 1990 to 1992. “There’s nothing I see in Trump’s plan that would do anything more than cover a couple million people.”

Robert Laszewski, a former insurance executive and frequent critic of the health law, called Mr. Trump’s health care proposals “a jumbled hodgepodge of old Republican ideas, randomly selected, that don’t fit together.”

The Times’ article features a variety of related observations. An AEI economist said, for example, that Trump’s plan “resembles the efforts of a foreign student trying to learn health policy as a second language.”

Left unsaid was a nagging detail: as woeful as Trump’s blueprint is, it’s par for the course in Republican politics, and his “plan,” while ridiculous, isn’t any worse than what any other GOP official has put forward in recent years.

James C. Capretta, a senior fellow at the Ethics and Public Policy Center, a conservative nonprofit group, said Mr. Trump underestimated how difficult it would be to uproot a law that was now embedded in the nation’s health care system.

“It took a herculean political effort to put in place the Affordable Care Act,” said Mr. Capretta, who worked at the White House Office of Management and Budget from 2001 to 2004. “To move in a different direction, even incrementally, would take an equally herculean effort, with clear direction and a clear vision of what would come next. I just don’t see that in Trump’s vague plans to repeal the law and replace it with something beautiful and great.”