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travails of Trumpcare
On Healthcare, GOP Should Think Long-Term
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  • Anthony (The AHCA)

  • Andrew Allison

    The way it is paid for, namely largely by taxpayer subsidized private insurance is precisely the problem with the cost of American healthcare. Neither employers (who provide most insurance other than Medicare) nor employees pay tax on the premiums, resulting in a huge loss in tax revenue. Meanwhile, private insurance companies maintain multiple, functionally identical, systems which impose an immense burden on the care provider (I’ve seen estimates that 25% of a typical practice’s overhead is insurance processing) and an administrative overhead roughly four times that of Medicare (thanks in part to the multi-million dollar salaries of senior executives). The lack of transparency in this ludicrous system hides the real cost of both insurance and care. As a result, neither employers, employees, insurance companies nor care providers have the proper incentives to control costs.

    • Jacksonian_Libertarian

      There isn’t anything we can do at this time about Medicare/Medicaid, or VA healthcare.

      But, we could make it illegal for Employers to buy their Employees health insurance. This would put the consumer back in charge, and the free market would force improvements in Quality, Service, and Price, just like it always does. Medicare/Medicaid and VA healthcare would benefit from all the improvements, and become less of a burden over time. The key is to put responsibility for healthcare back on the consumer, and get all these 3rd parties thrown under the bus.

      • Andrew Allison

        Prohibiting employers from providing insurance isn’t feasible. Taxing the premiums and making participation optional is. Another good step would be to eliminate the State barriers to insurance competition, and to permit insurance companies to offer whatever policy provisions they wish. The best thing to do with the irredeemable VA would be to abolish it and transfer its clients to Medicare. Unlike health insurance (including Medicare), Medicaid is strictly welfare. I’m inclined to think that block grants to the States and State management is the way to go.

  • WigWag

    Professor Mead gets it exactly right, we need a bandaid to stop the bleeding and a well thought out longer term solution to solve the problem.

    It is remarkable that after years of complaining about Obamacare, the GOP and Donald Trump are advocating a solution that will make things even worse. It would appear that the stupidity and venality of Republicans exceeds that of even the clueless Democrat nitwits. It’s hard to know whether to laugh or to cry.

    Like the Democrats, the GOP seems to think that the problem is mostly about the system used to pay for healthcare; it’s not. The problem is that American health care costs fifty to seventy five percent more than what healthcare costs in any other developed nation while delivering at best, mediocre results.

    If American healthcare costed what French healthcare costs, any payment system would work. Single payer would work; health savings accounts with high deductible catastrophic care would work. The Obamacare system would work. With American healthcare costing what it does, there is no plan that Democrats or Republicans can dream up that will be feasible.

    The problem that both political parties have is that they’re looking for solutions in all the wrong places. Healthcare costs too much in our country because providers charge too much for their services. All providers are to blame; doctors, nurses, hospitals, nursing homes, pharmaceutical companies are all villains and they are all protected by the most venal villain of all, the big bad health care cartel.

    That cartel, which does its dirty work by limiting the number of providers through absurd credentialism and the imposition of ridiculous regulations is, almost singlehandedly, destroying the American economy.

    Physicians should be earning 50 percent of what they earn. Hospitals should be able to deliver better care for half of what they charge.

    Until Congress confronts this reality, nothing will change.

    • FriendlyGoat

      Unfortunately, we do not have a Congress even REMOTELY wise enough propose anything other than dramatically cutting the income taxation of those medical cartel companies (including doctors) who, as you note, are already charging too much.

      • WigWag

        Jacob Heilbrunn at the National Interest gets it exactly right; Donald Trump made a huge mistake aligning himself with Paul Ryan on healthcare. Ryan’s plan is a disaster; it makes Obamacare look brilliant in comparison. If the changes advocated by the House “Freedom” caucus were enacted it would be even worse. A better label for this group of brainless Neanderthals would be the House Morons Caucus.

        I don’t totally blame Trump. He arrived in a hostile Washington, D.C. with no allies. He’s as reviled on the right as he is on the left. There are virtually no populists in Congress and GOP politicians are as disinterested in the plight of ordinary people as Democrats are (as long as they’re not transgendered, gay or self-identified members of some other “marginalized” group). As a result there’s no congressional caucus focused on advocating for the people Trump reached out to in his campaign. But none of this is an excuse for the pure stupidity the Trump Administration has displayed on healthcare. Trump would have been wiser to align with the Democrats to fix Obamacare in the hope of luring a few Republicans to his side then aligning with Paul Ryan who is little more than a hapless and hopeless Ayan Rand fanatic.

        Read the Heilbrunn essay, FG. As I said earlier, he gets it exactly right.

        • FriendlyGoat

          I’ve known “repeal and replace” was a crock and a joke for the several years they talked about it. It’s Trump’s turn to know too. He cannot do a “fantastic” health reform with Republicans. But (dang for him), he is married to the SOBs. And so are the rest of us.

          But what really needs to die is their dreams of tax reform. To that end, they lose in public opinion if they pass AHCA and they lose if they don’t. Starting off as the gang that can’t shoot straight is the best we can hope for in early 2017.

    • Boritz

      Just have to relate this personal story to you regarding medical cost. A few weeks ago I wanted to see a physician quickly. My PCP was unavailable (the new one, not the one that went concierge). The person who makes appointments looked for a different doctor who could see me more quickly but to no avail. She ended by offering to let me see a physician’s assistant and I agreed. When I got the bill my copay was exactly the same as to see an MD. I was unpleasantly surprised. If there was a cost-savings here it didn’t get passed on to me. I suppose the provider would say, hey you got in sooner so be glad of that. That’s all well and good but it’s kind of like being turned away at the five-star hotel because they have no rooms but the two star hotel that takes you in charges the same price as the five-star because, hey they had a room for you didn’t they. I suppose I could do some research and see if the insurance company saved but as a typical consumer of medical services I’m not that interested in what the insurance company is paying, only what they charge me me me. The bottom line is that prices don’t want to come down no matter what adjustments we make.

  • Arkeygeezer

    The phony politicians in Congress are exposing themselves; big time! Take note America and get rid of them.

  • Stephen

    There’s that phrase again: “universal health care.” I have yet to hear a good and commonly accepted definition of what that phrase means. The old problem associated with not rectifying those names raises it head again. Confucius would simply shake his head knowingly.

    • Andrew Allison
      • Stephen

        Heh. Well that certainly clears things up. When Thailand, Russia, Cuba, Botswana, and the UK are all said to have achieved, or at least satisfied the definition of providing “universal health care”, I would say that you might want to tighten up that definition a bit. That link illustrates my point. I doubt that voters in the US will ever be sold on “universal health care” as being well defined much their notion of the phrase, if you hold these countries up as models.

        • Andrew Allison

          The definition is perfectly adequate. Rather than asking for a tighter definition we should be asking ourselves why the world’s leading economy is the only member of OECD which doesn’t provide even the most flexible definition of it.

    • Angel Martin

      “Universal health care”. Want a definition, here is one.

      “No Doctors currently accepting new patients”.

      That’s right. There are no GP’s in the Victoria, British Columbia area (pop. ~400,000) taking new patients.

      Now I recently moved permanently to Victoria and did find a Doctor thru family connections. But if I hear the rhetoric of universal health care right, it’s not supposed to be that way.

  • Jacksonian_Libertarian

    Only the Free Market can deliver the high Quality, low Price, and Individualized Healthcare, that consumers want.

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