March 6, 2016

Position Paper: Free Health Care, Trump Style

Created with https://Tagul.com
Somewhat quietly, or more quietly than I thought he would have, His Hairness released his healthcare plan a few days ago.

Of course, it came with the usual bluster -- not unique to Trump, but an affliction they all seem to have, as if the sound bite about the plan is more important than the plan itself.
Since March of 2010, the American people have had to suffer under the incredible economic burden of the Affordable Care Act... passed by totally partisan votes in the House and Senate and signed into law by the most divisive and partisan President in American history, has tragically but predictably resulted in runaway costs, websites that don't work, greater rationing of care, higher premiums, less competition and fewer choices...the damage done by the Democrats and President Obama, and abetted by the Supreme Court, will be difficult to repair unless the next President and a Republican congress lead the effort to bring much-needed free market reforms to the healthcare industry.
So, what's the approach?  Well, "on day one" he'll ask Congress for a full repeal; the assumption is that what failed 50-some-odd times will pass this time. And it will pass, we assume, because
We will work with Congress to make sure we have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty to everyone in this country. By following free market principles and working together to create sound public policy that will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans. (emphasis Trump's)
Full repeal, of course, would put preexisting conditions back into play; would put older dependent children back into safety net programs; and preventative services, which now must be rendered without cost share, would go back into the mix of deductible and copays. Rules regarding admin costs as a percentage of total premium collected would also be out the window, allowing insurers to profit freely as they saw fit.

And mental health benefits might also suffer a hit, except that Trump notes (as do all politicians) that
Finally, we need to reform our mental health programs and institutions in this country. Families, without the ability to get the information needed to help those who are ailing, are too often not given the tools to help their loved ones. 
He points to some "promising reforms being developed in Congress" that deserve bipartisan report, but doesn't get into specifics.

Notably, his plan doesn't mention how he's going to increase access to healthcare as he emphasized above; his plan primarily addresses access to health insurance, which is a very different thing.

 Here are the other highlights:
  • Elimination of the individual mandate - because "no person should be required to buy insurance" unless they want to, proving once and for all that in America it's more important that we have auto insurance that might never be used than it is that we have health insurance that is the gift that keeps on giving. 
  • Sale of insurance across state lines, as long as the plans comply with the applicable state laws and regulations. This will drive costs down and satisfaction up, we're told. Here in New York, where we just experienced the free market free fall of Health Republic, I'm not sure lower premiums are all they're cracked up to be when it comes to insurance.
  • Review Medicaid options so that people don't slip through the cracks, and make sure that folks who want insurance can get it. This is for the people who cannot benefit from the free market bonanza that will save the world.  He also proposes Medicaid block grants so that states can do what they know best, and to incentivize the identification and elimination of fraud, waste and abuse. 
  • Allow tax-free contributions to health savings accounts (HSAs) which then become part of the person's estate with no 'death penalty.' The HSA funds could be used by anyone in the family, without penalty, and "should be particularly attractive to young people who are healthy and can afford high deductible health insurance plans."  (The young and healthy are the ones who are taking the penalty of the individual mandate instead of signing up for insurance because the penalty is less than the premiums.)
  • Transparency in pricing from providers, "especially doctors and healthcare organizations like clinics and hospitals" so people can price-shop.  
  • Cheaper drugs, via removing "barriers into entry in free markets for drug providers that offer safe, reliable and cheaper products." This includes access to "imported, safe and dependable drugs from overseas."  The free market, in pharma, gave us Martin Shkreli. And, who will make sure that the imported drugs are "safe and dependable" -- do we take the word of the regulators in the socialist, free-insurance-for-all countries that benefit from these prices now?
One more piece of the plan is this:
  • Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system.
Translated: government-sponsored health care. Free health care. Say it either way, doesn't much matter. I mean, say your income tax responsibility is $5,000, and say you pay $6,000 in health insurance premiums. That means that the $5,000 Uncle Sam is counting on getting from you is now $1,000 that Uncle Sam owes you. Which means that someone else is going to be picking up the costs, right? And if someone else is paying for your insurance, it kind of makes your health insurance free, doesn't it?

Multiply that by the millions and millions of Americans who have insurance, and it seems we're headed down a very bad path, don't you think, especially this is all to be done under our current tax system.

I'm not naive about the Affordable Care Act -- clearly it can be improved, starting with offering basic basic plans as an alternative to high deductible health plans, which are NOT for everyone even though they're less expensive -- but I stand firmly against full repeal. 

I support transparency, and I support requiring insurers, including the one I've worked at for almost 26 years, to spend less on admin and more on benefits. I support having more nurse-practitioners and physician assistants, particularly in lightly populated rural areas and very densely populated urban areas, so that people can access health care when they need it.  I support exhaustive efforts against fraud, waste and abuse in all government programs, including healthcare. I support challenging states to look critically at their safety net programs to reduce costs (and benefits, where they are overly rich) and to not shift the burden to local governments. There's more, but I'm not the one running for office. 

As Trump does, I support building a better economy, where more people are working and able to afford insurance. 

But one thing I don't get is how free health care offered by a Republican is going to Make America Great Again, when it's a sign of the apocalypse when it's offered by a Democrat.