Healthcare seems to be my generation’s hot-topic. Every election that I can well remember since Bush vs. Clinton has made it a pressing issue. Each President since at least Lyndon B. Johnson has done something to tweak it and thereby tie medicine to the state. One would think that past and present disastrous examples would be enough to illustrate why tying medicine to the state would be bad news, but I’m being too optimistic in thinking that the general populace studies history on a surface level, let alone in any detail to know of those debacles. Forgive my cynical pessimism. It’s not within my scope, however, to outline and illustrate that history. But for those who would like to know just a little more about at least one example of state/medicine relationships, Yuri Maltsev, a former Soviet Union economist, who worked directly under Mikhail Gorbechev explains how statist medicine devolves into nightmarish conditions. That’s the Soviet Union, however. What does Donald Trump have to say about the current state/medicine tryst?
Much can be said against Donald Trump, but his stated policy, if it can be trusted at face value, is not an area in which he could be criticized too heavily, if at all.
The opening paragraph of his policy pulls no punches. He rightly points out that Americans have and are suffering under the weight of an insane governmentally imposed medical policy. Further, Trump also rightly illustrates that the Affordable Care Act passed under extremely partisan conditions and was signed into law by an extremely partisan president. He then continues to rightly illustrate that the plan will fail under its own economic weight. Bingo. It will go bankrupt, which is why so many states in 2015 petitioned the Supreme Court in an attempt to nullify the legislation. They had to, or, as they correctly argued, will go bankrupt. The states lost. So did the people.
Trump properly sees the problem, and has laid out a 7 pointplan to fix it. Perhaps 7 points is too much. 1 point might have sufficed, just pull the government entirely out of the health-care market should do. He also seems to have faith that congress will work to repeal the legislation. I don’t. But let’s look at the 7 steps any way.
1. Repeal Obamacare. Do not force anyone to buy health insurance if they don’t want to. Yes. Simple, succinct, and spot-on. No one should be forced to buy anything they do not want to purchase. It’s easy for someone to see that forced purchase of a Lamborghini on a used Hyundai budget is unworkable, even insane. But that’s somewhat the same situation with America’s current Healthcare situation – except that Americans are paying for a Lamborghini and getting the Hyundai (with no tires, no gas, and no battery).
2. Modify existing law that inhibits the sale of health insurance across state lines. The idea here is to encourage competition, while returning more power to the individual states. This is a good idea, but I have to wonder how much government control/regulation will still be involved. Something seems to be implied if one reads between the lines. But taking him at face value, this point is not bad, and it’s certainly an improvement on the current, and even past health-care situation in America.
3. Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. I like it. Who in their right mind wants to pay more taxes? All politicians promise to reduce taxes, if Trump can enact this policy, he will have gone a long way to make this pledge a reality. (That’s not to say that Trump has not said negotiated higher taxes are likely).
4. Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. Anyone my age should have the best possible options for saving money against a rainy day. HSAs provide that savings possibility, but they are still regulated to potentially unworkable status. Trump understands that, and this point is a good one. Paying into a savings account, instead of paying into a plan that you might not use for decades is certainly a more intelligent idea. Get the government out of HSAs altogether is an even more intelligent idea.
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. I think I understand what he’s trying to say here. He’s trying to say that people should be able to know the cost for “xyz” procedures in a menu-style format. I’m guessing at that honestly. Either way, this is the 1 point of the 7 that I don’t quite like. It appears to me that Trump is hinting at regulation. In order to require price transparency, who will be hired to enforce that “law.” A health-care oversight tsar? Agreed, individuals should be able to shop around. The current system is obscenely and illogically subjective, and that is largely due to government oversight already in place. Remove that oversight, and costs will come down in a way that anyone can visually see. Just don’t use the government to regulate prices. That is a large part of the mess currently in place.
6. Block-grant Medicaid to the states. State governments do know their people better than the Federal government can ever dream of knowing her citizens. This is why there is so much anger about what the Federal government does. It seems as if they just don’t care about you. Realistically, they don’t (consider the 1 representative to an average of 735,000 people being represented, and you get the picture). The Founders knew that’s how a federal government would work, which is why many tirelessly fought for limitations on a centralized (general as they called it) government. They wanted, and intended, for the states to have the main authority. (Consider the 10thAmendment). State governed Medicaid, if we’re to have Medicaid at all, is better than nationally governed Medicaid. (The best option is to do away with Medicaid altogether mind you). Trump also mentions that the States already go above and beyond Medicaid requirements. This is generally true, but under Obamacare that truth will largely disappear. Bottom line, this point is average, but better than the current situation. I’m all for more power to state and local, and less power to the Federal.
7. Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Yes! Certainly the anti-vaccine crowd would like to chime in and regulate the pharmaceuticals out of existence, but that’s short-term thinking focusing on small scale issues. (Granted, in some cases they are indeed right, but that’s not the scope of this article). A person dying of cancer, who wants a particular experimental drug does not have 10 years to wait for that drug to be cleared by the FDA for use. Pharmaceuticals also would love to save the millions of dollars required, not for research and development, but for paperwork that must be filed with the government for each drug being manufactured. Removing barriers would help drive the cost of drugs down, and could potentially save more lives. (Yes, I realize that Big-Pharma often stands in the way of drugs or procedures that are better than what they’re offering. But the reality is is that Big-Pharma is often in bed with the government to keep those smaller companies or alternative procedures off of the market. Those barriers also must be removed).
The overall plan outlined is pretty good. It addresses short term issues, as well as long term concerns. Therefore it is balanced, and has the best possible intentions. That being the case, other than perhaps a few minor details on a couple of points, I don’t believe that one can be against Trump for his healthcare plan as it is written. The same cannot be said for how he plans to handle US/China relations. We’ll visit that tomorrow.