Category: Health Care
Posted: 03/03/16 00:40, Edited: 03/03/16 00:41
by Dave Mindeman
In the last debate, Trump got hammered about not having any plan that resembled a health care replacement for Obamacare. Which he is going to repeal, first thing, no question, make America great.
Well, let's go over the 6 points that have been put on the Trump website
as the "alternative" to Obamacare:
1. Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.
What needs to be indicated in this somewhat simple statement, is how pre-existing conditions will be handled without Obamacare protections. If you truly do not have to buy healthcare unless you want to - then why would you if you are young and healthy? You just wait till you have an illness that needs treatment and then place yourself in the hands of an insurance company that probably does not want to deal with your soon to be expensive health care.
2. Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
Trump seems to think that this is one of the common sense free market solutions that will be obvious....and will make America great. But the key is in the "complies with state requirements", part of this point. What you would probably see is a bunch of insurance carriers flocking to Mississippi to put out some cheap plans where they don't have to cover anything or can put a cap on coverage or eliminate preventive care -- or whatever cheap version of healthcare that Mississippi doesn't mandate about. Places like Minnesota where we want comprehensive coverage will probably only have carriers who are familiar with the coverages we have - and my guess is that premiums won't change at all.
3. Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn't Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
Except poor people and sick people who need coverage the most probably don't pay much in the way of taxes anyway, so a deduction will be of no benefit whatsoever. And as for ensuring coverage thru Medicaid - isn't that what Obamacare is doing right now? I guess it would depend on whether Trump's version will force states to take the extended Medicaid that red states are currently refusing.
4.Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.
Again, the people who need coverage the most, usually don't have a lot of extra cash lying around to fund these HSAs. It is no accident that Trump mentions estate carryover, because these HSA or Education funds are really just a rich person tax shelter that get passed on to their heirs. The rest of us go paycheck to paycheck - and an HSA is just a pipe dream.
5. Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
All this will do is give us a clearer picture of why we can't afford to pay for all these health procedures out of pocket. Pricing structures at clinics and hospitals are meant to take into account insurance maximums and contract pricing. If they put out some kind of consumer pricing list, it will just be the maximum price allowed, because they know only an insured person will be able to afford it anyway; and pricing will be determined by the insurance contract. Another "make America great again" con.
6. Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
Of course, the block grants. An old Republican trick. The states get the Federal money and figure out ways to make the grant pay for roads or bridges or tax cuts. They may know their people best, but they also know how best to give their buddies bigger tax cuts as a result. You have to have country wide standards on health care - states will take the cheapest route available - some more than others. People should not have to worry about what their healthcare covers based on where they live.
7. Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.
We could have had this years ago when the Bush administration pushed Medicare Part D through Congress - with a provision that forbids the government to negotiate prices with the pharmaceutical companies. That is what we should concentrate on changing. Importing drugs from overseas should still pass through the FDA because some countries use shortcuts to bring new chemical drug entities to market. If we are "making America great again" then why do we need to be importing drugs?
That is the extent of the Trump plan. A hodgepodge of old ideas that have problems on their face. It says nothing about pre-existing conditions, or children on family policies to age 26, or eliminating caps,or subsidies to help with premiums for lower income families. And how will hospitals pay for care involving people that have no insurance coverage? Same old problems.
Maybe that is what "making America great again" means - we just go back and do the patchwork and bandaid measures that we did before comprehensive health care reform.
Doesn't sound all that "great" to me.