Robert Hayden, DC, PhD, FICC
March 2010 marks the beginning of Obama care in America. It is imploding on its own weight as, to use a favorite word of its authors, it is not “sustainable.” It has pulled business and personal income in a negative direction for as long as it has existed. It is not surprising that the first step of any Republican plan is the repeal of this failed Democrat-only scheme.
The stated goal of healthcare reform in a Trump regime would be to broaden access to health care, make it affordable, and improve the quality of care delivered to all Americans. We have heard these words before, with the possible exception of the last three, so we are justifiably skeptical to hear them again. After all, remember Obama’s lie, “If you like your Doctor, you can keep your Doctor?”
A President Trump would look to Congress to repeal the individual mandate on his first day in office, even before someone has swept up the confetti from the inauguration. Trump believes that no American should be forced to buy something he or she does not want or cannot use.
Almost every Republican plan involves modification of existing law to allow sale of insurance policies across state lines. The design is to open competition across those state lines to drive cost down and choices up.
As good as that sounds, there is a problem with it. The last time I checked, there were 26 states, Georgia included, whose state legislatures had passed bipartisan bills (unlike Obama care) which include safeguards for citizens who buy health insurance. The safeguards are called state-mandated benefits. These benefits represent many hard-fought legislative battles and compromises to include certain basic coverage for items deemed important by the people of those states.
Most people do not read the fine print of their insurance plan. Could you accurately predict whether insurance would cover the frames for your eyeglasses, your colonoscopy, your mammogram, or the equipment for your sleep apnea? Twenty-six states have mandated benefits, while twenty-four do not. Comparing contracts among those states might well be an apples-to-oranges comparison that most people would not understand.
For example, if you live here in Georgia where state-mandated benefits are in your policy, you might find a state without state-mandated benefits whose policies might be a little less expensive. You will be tempted to invest in a cheaper policy. You might be less than delighted to find out later that benefits you counted on having and would have here in Georgia do not exist where you bought your policy, so your coverage is gone. Like most people, you may not have caught that in reading the contract. Nevertheless, insurance benefits that you counted on having because you live in Georgia might well be gone.
By the way, this approach would also neutralize the state insurance commissioners in the 50 states. These are elected officials who protect the public from unscrupulous insurance company policies and behaviors. Do you want that protections stripped away from you?
The last time this came up, we found that services such as optometry; cancer screenings, including mammograms and colonoscopies; most women’s health services; men’s health services, including prostate exams; well-baby exams; and, supplies for insulin-dependent diabetics might well not be covered without Georgia’s state-mandated benefits.
As a healthcare provider, I can tell you that removal of coverage for diabetic supplies will cost lives. Some insulin-dependent diabetics are disabled and on fixed incomes. Without insurance assistance for those supplies, they will not take insulin. They would not be with us for long.
There is much in the Trump plan that conservatives would support. There is a rather large caveat, however, when it comes to selling policies across state lines. If we could stipulate that comparisons would be honest so that people would know what they are buying, or more importantly, what they are not buying, this could be, in Trump’s words, “a deal.”
There are some very positive things about the Trump plan. Health insurance premium payments would be fully deductible on your tax returns. Health savings accounts (HSAs) would be tax-free and contributions would be allowed to accumulate. These contributions would become part of your estate and could be inherited. After all, it is your money, even if the current regime does not see it that way. Inherent in these features is a fundamental difference between this plan and Hillary’s: in one world you control your choices, while in the other world the government or an insurance company makes the choices for you.
Price transparency would be required of all healthcare providers so that you can shop the best possible rates on procedures, exams, etc., creating competition in a free market. Choices would be your own, not those of an insurance company, a government, or a bean counter hiding in a basement.
Medicaid money would be distributed in block grants to the states, decentralizing control to decision points closer to the consumers. This would cut some overhead and save Medicaid dollars.
The pharmaceutical industry is in the private sector, but provides a public service. A Trump administration would remove barriers for drug providers who have demonstrably safe products so they could enter the free markets in this country, delivering reliable and cheaper pharmaceuticals. Again, competition would work in favor of the consumers if it is fair.
The Trump healthcare plan is inextricably tied to the enforcement of immigration law. Right now illegal immigrants are costing $11 billion annually in healthcare money to which they are not legally entitled. This expenditure would significantly increase under Hillary’s plan that will cover everyone “without regard to immigration status,” all on the backs of American taxpayers.
Another caveat is this: no matter who wins this election, rest assured there has been great damage done to health care in America in the last eight years. Think of it this way – knowing what you know about healthcare reimbursement now, would you borrow and spend $250,000 - $500,000 to go to school? Would you take that risk in this market? If not, you understand why there is a doctor shortage. That will not go away quickly. We must fix this system so that it is worthwhile for people to take the risk and make the sacrifice necessary to become a healthcare provider. Until we do, there will be significant manpower shortages across the board.
And, I reassert: there has never been a time in American history when it makes more sense to just stay healthy.