Stanley Feld M.D.,FACP,MACE
I am going to review your healthcare reform platform for those liberal “experts” that have determined you do not have a viable alternative to Obamacare.
It must be noted that President Obama’s healthcare “experts” created a non-viable and expensive healthcare reform disaster.
Only 1 million of the 20 million the Obama administration brags have signed up on the health insurance exchanges this year have actually signed up. There are only 6 weeks of open enrollment to go until January 1,2017.
You want congress to;
- Completely repeal Obamacare.
You have not told us how you are going to do it. It has to be repealed. I trust you will find a way.
2. Eliminate the individual mandate (tax according to the Supreme Court).
No person should be required to buy insurance unless he or she wants to. This is a basic freedom of choice.
3. Modify the existing law that inhibits the sale of health insurance across state lines.
You are assuming that eliminating state line restrictions will allow full competition in the healthcare insurance market place.
You assume this step will allow insurance premiums to decrease.
The healthcare insurance companies will try to keep the insurance premiums high in all states even though there are demographic and health risk differences.
At present, Medicare outsourcing administrative services to various health insurance companies does the adjudication of claims. I assume the job go to the lowest bidder.
The insurance companies typically take 40% off the top for administrative fees. Many of those fees are bogus. Medicare and Medicaid are being ripped off. The government must know it but nonetheless permits it.
Only a consumer driven local system can work to lower costs. It can only work if all price information is transparent to consumers. Consumers can the shop for physicians and coverage they need using their own dollars.
You are ignoring the huge problems in keeping premiums down and competition high with selling insurance across state lines.
“The barriers to entry for the insurance industry providing healthcare insurance across state lines are not truly regulatory, they are financial and they are network producing,” Sabrina Corlette, the director of the Georgetown University Health Policy Institute told the New York Times last year.
“Consumers need to have an adequate network of doctors and hospitals in order to get the care they need and that means insurers have to spend more money to pay these providers.”
“ Since it’s a costly proposition for the insurers to build these networks of doctors and hospitals in new regions, health plans aren’t generally willing to enter new markets, analysts say.”
“Sales across state lines would reduce premiums for those who are healthy at a given time while increasing premiums and reducing access to coverage for those with current or past health problems,” according to an analysis earlier this year by the Urban Institute’s health policy center.
Sales of insurance across state lines would impinge on states’ rights.
You (Donald Trump) and Republicans have not thought out this proposal very well. I do not believe it will work to decrease the cost of premiums.
- Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system.
This proposal is essential.
Individuals should be allowed to take the same tax deductions as group insurance plans. People who buy individual market insurance should not be forced to pay premiums with post-tax dollars.
- Review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
This is where your proposal is weak. Medicaid is a failure. It is almost as bad as the VA health System.
Its failure presents a powerful argument to not have government control any of the healthcare system.
The recipients of the program are treated as commodities. They are shuttled through the system like cattle.
Medicaid must be modified. Medicaid recipients should be incorporated into my ideal Medical Saving Accounts program.
The government should act as the funding agent for the eligible poor. This will put the poor on the same payment footing as everyone else in the Medical Savings Account System.
The Medicaid eligible poor should be given financial incentives to take charge of their health and healthcare dollars.
At present they struggle to see a physician only when they are sick. The system increases the total cost of healthcare.
Our healthcare system must be moved from a system that fixes you when you are sick or broken into a system that rewards people financially for remaining healthy and controlling their healthcare spending.
It is much cheaper to avoid the cost of emergency care than it is to get sick and have to go to the emergency room.
Review of your healthcare reform proposals will continue in my next letter to you.
In the meantime have a Happy Thanksgiving Holiday.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
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