Commentary Health Systems

If Trump Had to Navigate the Same Medicare Choices Many Older Americans Do, Would He Still Lie About It?

Matthew Cortland

This isn’t a health-care service and delivery system. It’s a byzantine maze constructed by the GOP decades ago.

What if President Donald Trump had to sign up for his own Medicare coverage? As a health-care lawyer, I often help my older clients navigate the Medicare maze. Perhaps in years past, Michael Cohen, Trump’s long-time personal lawyer and fixer, did the same for Trump. But after Cohen pleaded guilty to eight federal counts, including crimes in which he implicated Trump, we can imagine POTUS sitting down at a computer by himself on the first day of Medicare open enrollment, October 15.

My hypothetical is, of course, absurd: Trump doesn’t use computers. But suspend your disbelief and imagine Trump opening a browser, going to Medicare.gov’s “Medicare Plan Finder,” and trying to use the “Basic Search” tool to find which Medicare plan he wants to enroll in for 2019. In his USA Today editorial published Wednesday, Trump argued the current Medicare system is working well for older Americans because it provides them with “choice.” Would he continue to lie about Medicare if he saw how few choices the millions of people who rely on it actually have? Would he even have time to sign his name to an op-ed? Or would navigating all of the false choices the partially privatized Medicare system presents take him until December 7—the close of the open enrollment period?

Choosing which of their seven residences to sign up for Medicare from isn’t an issue the average Medicare beneficiary encounters, unlike Trump. But he might begin using the Medicare Plan Finder to choose a plan by entering the ZIP code for Trump Tower:

[Photo: A screencap of the Medicare.gov website with "10022" entered in the search bar]

This tool next asks how the user gets their Medicare coverage, whether they receive financial assistance, and if they would “like to add drugs.” (As a chronically ill patient with a severe case of Crohn’s disease, I’m usually in favor of adding drugs, but Medicare.gov actually means to ask whether the user wants the search to take account of their prescription medications.)

We know from former White House Physician to the President Rear Adm. Ronny Jackson that Trump takes four prescription medications:

Rosuvastatin (Crestor), 10 mg per day for high cholesterol;
Ambien, as needed during travel, for sleep;
Finasteride (Propecia), 1 mg per day for hair loss;
Ivermectin cream (Soolantra), as needed, for Rosacea;

Propecia isn’t one of the drugs listed by this Medicare.gov tool. Finasteride, the generic name for the medication, is listed but only shows one dose: 5 mg. The 1 mg Trump takes is not listed. After discussing Finasteride with a physician, I puzzled out that at 5 mg per day, finasteride is used to treat prostate enlargement and is covered by Medicare. At 1 mg per day, it’s used to treat baldness and isn’t covered by Medicare. Would Trump be confused by this?

[Photo: A screencap of the Medicare.gov website showing several different options for prescription drug coverage]

After selecting the pharmacy he uses, Trump would see there are a total of 68 plans for him to choose from.

Even after eliminating finasteride for hair loss, according to the official federal government tool designed to “help” Medicare beneficiaries select coverage, precisely none of the 68 available plans have all of Trump’s prescription medications on their formulary, which is the list of prescription drugs covered by a prescription drug plan offering prescription drug benefits.

Sixty-eight total plans: Original Medicare; twenty-three Prescription Drug Plans with Original Medicare (also called Part D plans); forty Medicare Health Plans with drug coverage (also called Part C plans); and four Medicare Health plans without drug coverage. And yet not a single option that covers all of Trump’s prescription medications. This is absurd. What, exactly, is the point of choice if none of the options provide the medically necessary care you need?

Next, Trump might ask the website to show the plans alphabetically (one of eight different ways plans can be sorted). Aetna was first. But it’s worth noting that Aetna’s plans are sold under dozens and dozens of other names.

[Photo: A screencap of the Medicare.gov website that shows dozens of names for Aetna]

But even when Aetna’s products are just marketed as “Aetna,” there are still half-a-dozen different plans to choose from. What’s the difference between Aetna Medicare Rx Select (PDP), Aetna Medicare Rx Value Plus (PDP), Aetna Medicare Rx Saver (PDP), Aetna Medicare Value Plan (HMO), Aetna Medicare Elite Plan (PPO), and Aetna Medicare Premier Plan (PPO)?

To answer that question, this display is supposed to allow Medicare beneficiaries to select plans to compare:

[Photo: A screencap from Medicare.gov showing different health-care plan options]

Between just three of those Aetna products, the premium varies from $17.10 per month to $58.80, while the estimate for annual drug costs, which is very much only an estimate, spans $2,505. And that’s just for covered drugs: Again, no plan covers all of Trump’s drugs and every plan features “drug restrictions.” Although Aetna is a useful hypothetical, it certainly isn’t unique; other insurance companies have similar complications for beneficiaries to wade through. For each of the plans that offers drug coverage but restricts that coverage, Trump could click through on the “Drug Restrictions: Yes” line to see details like this:

[Photo: A screencap from Medicare.gov showing the different drug restrictions for each plan]

If you’re feeling confused, well, you should be. This isn’t a health-care service and delivery system. It’s a byzantine maze constructed during the George W. Bush administration with the passage of the Medicare Modernization Act of 2003. Although Bush failed to privatize Social Security, the GOP succeeded in implementing a system designed in conjunction with Big Pharma and the health insurance industry to extract money from Medicare and distribute it as profit among corporations that jockey with each other for market share. That’s choice of a sort, but it’s a sucker’s choice. And Trump is betting we all fall for it. By lying about the lack of health-care choice, Trump hopes to scare older Americans into voting for him.

My grandmother left grade school to work in the textile mills to help support her family—she didn’t inherit hundreds of millions of dollars. She doesn’t know how to use a computer, and a demyelinating condition has made it difficult for her to use a fork, never mind a mouse. Unlike Trump, she actually needs Medicare. That’s why, during every open enrollment period, I wade through all of the “choices” to make sure she has the best Medicare plan available.

She doesn’t need more choices for which health insurance corporation will get her Medicare dollars. She doesn’t need more choices for which plan will restrict her access to medication. She needs us, as a nation, to choose a Medicare system that comprehensively covers all of the medically necessary treatments her physicians prescribe. In the meantime, maybe ask the older folks in your life if they need help navigating this absurd system.

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