(From https://www.donaldjtrump.com/positions/healthcare-reform)

HEALTHCARE REFORM TO MAKE AMERICA GREAT AGAIN

Is this plan crazy?

My guess is a lot of people are going to take little to no look at this plan, and immediately verbalize their opinions about, even recommendations against it.

The sources for resistance to such a plan, at this point in time, is where the U.S. stands in regard to the presidential race.

A year or so ago, I was still supporting the Obamaplan rather steadily and daily in my postings on LinkedIn, ScoopIt!, and even this site.

This changed when the news was out on the use of penalty fees for patients – – – or should I say potential and returning patients — to hesitate about filing due to concerns about hidden costs, accrued on a per need basis, such as co-pays.  The penalty fee was recommended for those who failed to commit to a plan, or failed to sign up for one when that was the expectation.

Most people don’t file for insurance due to limited incomes, even those from the middle class.  Myself included, the costs for adding my name to an insurer’s program, in addition to the amount I would probably have to pay when I went for care, especially emergent care, puts patients in a position where the impact is the same no matter what decision you make, about pre-paying or pay once the need arises.

But still, the worst part about the Obamaplan is that it penalizes every one involved in health care, from the patient to the physician and nurse, to the administrators and hospital staff who have to make up for losses accrued when patients, insured or not, cannot comply with the rise in health care that the Obamaplan resulted in.

That one good thing about the Obamaplan is that is covered a significant number of people who were a month or two earlier uninsured.  But that really isn’t worth the amount of members lost in healthcare plans due to the costs involved.  And it certainly doesn’t make up for when insurance companies and states decide to bow out of the Obamacare plan, like North Carolina did, in order to avoid having to deal with the problems inherent to its operation at the insurance company level, the health care facility level, the billing agency level, the collection agency level, . . . and oh yeah, the patient level.

When a plan doesn’t care who it impacts and turns into a victim of change, that plan is not at all democratic or “American” in nature.  It is totalitarian or oligarchic like in nature–it only benefits the few programs in charge of these operations.  It only benefits the patients and administrators who don’t have to subscribe to this “New Deal.”

In 2015, New York City had 1.4 million patients enrolled in a medicare/medicaid program.  Due to the Obamaplan, in less than 6 months, this membership dropped to 1.25-1.33 million, depending upon your definitions.  That is a 0.o7 to 0.15 million drop in insured patients–or in real numbers, a drop of 70,000 to 150,000 patients in half a year.  The Obamaplan is not intended to increase enrollment.  It is intended to change enrollment.  The cost accrued by the patients who did depart their previous plan, may now be uninsured, and cost the newly insured more for healthcare by the end of a year.

So relating this to the Trump plan, the goal of the Trump plan is a generic one, plainly stated, focusing on the most important parts of healthcare that all os us like to complain about.  The Trump claim is as follows: “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.”

The next section is a description of seven attributes to this program meant to improve the healthcare system, as it exists now.  As follows . . .

[Begin Quote]

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Congress must act. Our elected representatives in the House and Senate must:

1. Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.
2. Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
3. Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
4. Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.
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.
6. Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
7. Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.

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[END QUOTE]

Entitlement 1.  We’ll begin by skipping this first order, except for a brief comment.  People have a choice about whether to pay for care or not.  There is a problem with this ideology for, which is if employers decide to no longer give in to providing some form of health insurance as part of the employment process, that the current markets out there will turn into haves and have-not industries.  Big businesses will reward employees with healthcare coverage.  Minimum wage or low wage businesses will hire, but make its workers poorer if they have to pay for health insurance on their own.

Entitlement 2. Remove the cross-state border issues with healthcare.  This is a new one to me, having worked in healthcare, medicaid and medicare claims related issues.  Sure, there are problems with obtaining insurance from your federally subsidized and funded state agency–like Medicaid and Medicare.  And programs that cover people in this way, always make it more expensive for you to receive care from an out of state facility.  Even more, if you obtain care from an unapproved facility, provider, company, without preapproval, this care could very well cost more as well.   The cross-state borders concern may help certain people receiving certain forms of care.  In places like NY, where people may cross over to Connecticut to receive better care due to the location of an Acute Care hospital, this problem theoretically already exists.  Yet it has not hampered upstate NY care that much.  I would need to see more details about what interstate care this clause pertains to.  More important perhaps would be a similar clause allowing patients to travel for less expensive care, by engaging in the now rapidly growing medical tourism industry.  I would rather have my colonoscopy performed for $1,000 instead of $5,000 to $7,500, and on a nice Caribbean Island rather than is a grimy urban neighborhood, where the hospital or facility is surrounded by everlasting construction events and hazards, and inadequate parking space.

Entitlement 3.  Allow individuals to deduct health related costs from their annual income tax returns.  Not at all contestable.  This should have been there from the beginning.  The government has to either choose to pay for your healthcare entirely, and tax your full income, or deduct what you have to pay as a matter of governmental choice.

Entitlement 4.  Health Savings Accounts–why do these opportunities keep returning? It is the choice of the agency providing them that is responsible for this decision.  The company is irresponsible with this potential healthcare insurance option.   This is also like that option you have, that comes and goes, of putting some money aside that is pulled from your paycheck, for miscellaneous health expenses.   You lose it if you don’t use it up by the end of the year.

Entitlement 5.  Price transparency.  This is where I can get personal about all of this.  A procedure performed on a medicaid patient, that costs $350, will inevitably cost a patient covered by some form of commercial insurance two or three times as much.  The low cost for the medicaid patient is because the government only covered a little under 50% of the billed amount, and the healthcare facility/insurance company usually is expected to accept this drop in payment.  So they make up for the medicaid, unemployed and disabled patient induced losses in income by doing something one step short of deliberately overbilling those who can afford to pay.  What’s worse about this aspect of healthcare billing habits is that a single procedure can have many different costs for the many different parts and programs in the U.S.  Costs for care are not defined as having to be within a given range, or for a specified amount.  Potential costs for opting for a healthcare service should be transparent to the patient population.  People like myself, who analyze and company the different BCBS’s and United *** insurance agencies, can determine where overbilling is being performed strategically, at the agency level.  How else can we compare the cost for a procedure nationally, if we continue to accept these varying differences in billing strategies and amounts. Such inconsistent pricing makes it impossible to safely evaluate the cost for healthcare and the Big Data level.  I use my own price sheet to review and compare these plans.

Entitlement 6.  Block Grants.  Nothing completely new here.  Not like this hasn’t been done before.  The thing to do is make block-grant required.  For some states, this means we go back a few years, or generations, in terms of how the state managed its patients.  The history of this type of payment plan is already in place, due to Medicaid and Medicare.  We use Block Grant like options as well for other things we do, such a develop new schools, or determine where to invest in certain infrastructure requirements in decomposing urban settings.  IF not for the failure of that last use of clock grants, we could argue that this method could work very often.

Entitlement 7.  Remove barriers for the marketing of healthcare.  As usual, that is always a good option, but it can result in a unique set of have and have nots.  Some form of care is essential, and overcharging for it is an issue.  It’s like saying the poor cannot have the best surgery, only the quick fix.  There are already a lot of rules an regulations about invention, marketing, testing of new products.  There is nothing new inferred by Trump’s plan regarding the expected rules to remain in effect regarding patient safety.  Trump’s proposals will not cause another Thalidomide tragedy to erupt.  Pharmaceutical industries are the cause for their own demise, or lack of success with their products, as the controversies behind certain unproven medications continue to show.  This issue has to be evaluated more strategically, and with more detail.  The one form of healthcare that needs to be added, once again, is the medical tourist industry option, for expensive processes, but maybe for alternative means of cultural healthcare processes as well. (It’s up to you if you want the Brazilian shaman to heal your Pinta or Chiclero’s Ear, or the African medicine man to treat your African American heritage induced genetically-derived cardiomegaly.)

So what’s Missing?

I’ll review that next.