Thomas,

I think Marcia is extrapolating on my earlier post about a $47T Medicare deficit I attributed to her. ;-)

Now being serious: people tend to focus on premium price when discussing the ACA, but actually a guiding principle of the ACA is to tackle healthcare cost inflation in the already most expensive healthcare system in the world, by far.

Trump threatens to repeal the ACA, but he also talked about negotiating a better bulk purchase Medicare deal with Big Pharma and other suppliers. Truly massive US markups should allow a competent negotiator to secure an immediate at least 20% drug cost deflation, dropping the deficit by considerably more than that because of the way deficit is calculated. And that's just the beginning when US prices can be more than 1000% of prices paid elsewhere.

Unfortunately cost deflation of up to 50%, or mega-inflation of the US dollar, now are the only ways to cover an essentially unpayable Medicare deficit.

So Trump's negotiation idea makes sense- except that in 2003 the (Republican) Congress passed an act preventing federal government using its negotiating power to reduce Medicare supplier prices. Not sure why this isn't all over the media, because the current Republican Congress would need to repeal this law before Trump legally can negotiate Medicare rates, which I think is why his Jan 31 meeting with Big Pharma execs didn't seem to do much at all.

Even if the law can be bypassed by pressuring Big Pharma across the board rather just for Medicare, drugs only amount to about 10% of total healthcare spend with other supplies about 5% - so Trump can be the best negotiator on the planet and it's only the beginning to bring down healthcare prices.

Big Pharma is powerful and won't want to cede the massive markups enjoyed for no obvious reason, so where is the MSM to put pressure on Congress and suppliers to sort out this self-serving mess? The viability of Medicare is at stake. No joke.

Unfortunately every day of inactivity, snowballs that awful deficit and costs Americans a fortune in insurance premiums.