It should come as no shock to anyone that Trump has already signaled that he plans on keeping parts of Obamacare. In fact, he plans on keeping two of the most useless and costliest parts. And that’s just to start. Keep in mind this is a man who said that he admired Canada’s single payer healthcare system and praised it for working (and it works as well as any of the financial blackholes that have the name Trump on them, so when we see a system that loses money, hurts people, and is a complete failure, I can see why Trump would think that is the perfect system to love). I’m sure Trump will end up not only loving every single part of Obamacare, but also demand that it be expanded.
Now, luckily, Trump doesn’t get to write law—Congress does. Unfortunately, Congress over the course of the last year became a bigger bunch of sycophants and losers than they’ve ever been. So, I’m not sure if I can trust them either. And there exists the possibility that Trump will veto anything that isn’t exactly what he wants and rather let the nation still suffer under Obamacare until he gets his terrible plans (if he has any). So, this could go really badly.
But let’s hope, let’s really hope, that Congress gets a good law through (fingers crossed, but if I had to put down money at this point I would bet we don’t get anything better…but what do I know, I thought the nation would have better sense to nominate and then elect this fascist hack…so maybe I’m wrong).
But the simple facts of history don’t help….
How we got here
Health insurance plans really began during the Great Depression, when being barred from giving people raises by a federal government that had no clue what constitutional limitations were, companies started to offer benefits packages that included health insurance. Before this doctors and hospital visits were primarily an out of pocket expenditure…and because they were not guaranteed, a constant supply, doctors had to keep costs low and services high to get business (remember the concept of the home visit?). Now a business offering insurance did not change much immediately as few people were getting these kinds of benefits. But it planted the seed of the idea…more and more employees would get insurance over the years. This has a few effects. The insurance companies, as they get larger and larger try to do what all companies do, standardize and cut costs and increase profits (more stock holders to pay). So, this requires the doctors who work with these companies to begin to standardize their prices (i.e., they have no incentive anymore to undercut their competition). This continued for a while and didn’t create too many problems, as the effect of insurance companies was never large enough to throw off the free market pricing by more than the smallest deviation.
But then America was tormented by a racist socialist by the name of Johnson. And with this idiot came monsters of Medicaid and Medicare. Now government could control medicine in a way only previously feared. First off, as with any government program, came fraud, billions of dollars of fraud a year. So even if you weren’t getting the medical care from these terrible programs, you and your tax dollars were getting stuck with the check. You ever seen those ads for all the Medicare products you can buy on late night television? Well you paid for the ad and the for the Medicare recipient to get the product they were advertising (few of which are actually worth the money being shilled out for them, even if they were paid with money that wasn’t stolen.) Further they inflated prices. Partly because they would only pay doctors a portion of what they would usually charge for a service, procedure or prescription causing the prices to rise if doctors who were participating in the plans to raise their prices if they wanted to make enough to stay in business (which in turn allowed all doctors to raise their prices and still stay competitive). This also had the problem of every subsidy…whenever you subsidize something you get more people wanting it…so although you have the same relative number of doctors you now have a massively larger population going to the doctor…and not for things like yearly checkups or major medical problems, no, now they were going for flu symptoms, minor cuts, and a host of other things that had they had to actually pay for the service they would have decided it was not worth the cost and better to just get some rest and let the body do what it was designed to do: heal itself.
And as the Medicaid and Medicare roles expanded, and as the Department of Health, Human Services and Education’s power grew (Thank you Ike for that stupidity…yes, the interstate isn’t the only thing from the Reich that Ike brought back with him) the completely predictable happened…prices went up, options went down, service went down, grief went up (granted the increases might have only been noticed by economists…but the seeds for larger disasters were being sown). So, the fact that government intervention up to this point had always and without exception led to making the system worse, the government intervened…with that creation straight from Eighth Concentric Circle of Hell, Health Maintenance Organizations (HMOs). Why were HMOs so dumb? Well first think of all the problems mentioned before, but on Captain America level steroids. Added to that HMOs genius idea was that they were going to cut down on the cost for the major portion of health care (all those major diseases and surgeries) by putting a lot of money into this thing they liked to call preventative care. The idea was that if we can catch the disease beforehand then we can stop it and not have to pay for those major medical problems. And that would work, if you know, you weren’t dealing with people. The problem of dealing with people is that we die. Without exception, we die. And the end usually isn’t pleasant or cheap (it could be, but people would rather waste a lifetime’s worth of wealth in pain and constant medical treatment to gain 3 years instead of living well for six months with a few pain killers–pro tip, you’re going to die–nothing will stop that–and the quality of what you have left is more important than the quantity you have left). So now, we’re not only spending massive amounts on all the major medical expenditures we were before, but also spending a massive amount on preventative care…oh, and paperwork. More overhead and paperwork than you could ever want to imagine. And of course life expectancy has not been increased because of all this preventative care, nor quality of life…so we’re spending a fortune on nothing.
So, to fix this mess which just made everything worse the government reached into the bowels of the abyss and pulled out Obamacare.
Am I the only one who has noticed that every government “fix” to the medical system makes it exponentially worse?
So the solution is simple. No more government fixes.
ALL OF THIS MUST BE STRIPPED AWAY.
But there’s a caveat. A BIG ONE. It must all be stripped away over time. You can’t take millions of people whose only medical care comes from these programs, and who honestly need that medical care to function, and just tell them that we’re canceling the program and they’re just up shit creek. I know there is this populist dream that we can just kill entitlement programs that they don’t like (the irony is of course that most populists engage in some kind of entitlement program, but they’ll tell you how that’s important, it’s just the programs they don’t use that aren’t important. It’s not really all that shocking that these people felt a bond with a Trump, a man who everyone with a DSM is fairly certain is a clinical narcissist.) This problem is with bad legislation—bad legislation can never be just killed because it creates systems that become self- perpetuating and societal needs that can’t just be ignored. This was why stopping Obamacare in 2012 was so important, because then we had the chance to kill it before it was really put in place. Now there are people who had insurance before Obamacare but who would not have said insurance if you just killed it. There are a lot of people like that, and if you don’t have a plan and legislation to make sure they aren’t left out and have a chance to transition back to the private sector you’ve actually made things WORSE than before Obamacare.
So, get rid of Obamacare, every last scrap. Get rid of the HMO laws. Get rid of Medicaid and Medicare (if you have concern for the groups that these programs cover, give them the money you would otherwise give them as cash, lump sum…it will save billions a year–in the long run trillions on overhead costs, fraud, and bureaucracy alone…or better yet, go to a reverse income tax). Get rid of all laws taxing, regulating, and controlling the medical industry. Discontinue the Department of Health and sell the buildings…get rid of the FDA and charge the bureaucrats with the millions of murders they have done by preventing life-saving drugs from coming to the market. Get the government out.
BUT GET IT OUT OVER TIME. There are no quick fixes with problems like this. And people have to realize that.
Now while we assume getting rid of the mandate and most of the regulation is pretty much given, what the Obamacare replacement needs to look like is something like what follows:
Suggestion # 1
So, that’s the first thing a new law needs is to be a long term plan. But that plan can involve certain things right up front. (Of course the problem here is that Trump is not a long-term thinker, and neither is most of Congress).
Suggestion # 2
Tort Reform. Tort Reform. Tort Reform. Every state that has instituted tort reform has seen medical costs drop, the number of doctors increase, the number of unnecessary procedures drop like a rock and even the number of deaths drop. If the federal government and every state were to institute real and sweeping tort reform you would see every single thing you buy drop in price, but you would probably see the biggest increase in the quality of medicine. (The problem here is that a sue happy lunatic like Trump is actually one of the reasons we need tort reform, and I don’t see him signing a law that will hurt his ability to sue people…we’re talking about a man who wants to do away with the First Amendment so he can sue people for telling the truth about him being a worthless sack of orange shit posing as a human being, tort reform is not going to be a priority for him).
Suggestion # 3
We need to allow insurance companies to cross state lines. Right now all insurance companies are banned from selling insurance across state lines. Look at any insurance card you have. Farmer’s Insurance of California. Blue Cross of Arizona. There may be a national corporation, but it owns 50 separate corporations in 50 different states. That’s a lot of overhead. It also stifles competition. A smaller company can’t expand beyond its own state because it can’t afford to set up a whole infrastructure to have a multi-state operation. This limits competition, and as anyone knows the less competition the higher the prices. If we remove the federal block against insurance crossing state lines you will see drops in every form of insurance you have: medical, car, house.
Just those two things would easily drop some of the the cost of health insurance to probably 70% of its pre-Obamacare costs, perhaps more. As seen from previous examples of when insurance was open to more competition, even within state lines, prices will drop radically.
(But here’s the problem, while Trump has made a point of insurance crossing state lines, that is inherently a free market argument, that trade barriers hurt trade. And I don’t see Trump signing a bill that undercuts his racists delusions that barriers against trade with other nation is a good thing. Maybe I’m giving him too much credit for consistency, but I get the feeling one of his toady advisors will point out the contradiction and say it’s best to be consistent).
But why stop there? Doctor’s bills themselves also contribute to a large portion of the costs. So, what can we do there?
Well a lot of the initial costs come from the fact that when doctors start their career they are laden with college and med school debt. Obscene levels of debt. So, let’s fix that.
The reason why college costs are so high is because the federal government subsidizes them at outrageous prices. Subsidies always increase costs. Always! So, cut all tuition subsidies and grants. Within a year you will see college costs drop. Now this won’t have an immediate effect as the doctors without massive debt will be years away from entering the market, but long term this will not only solve part of our medical problem but our massive college debt problem. Doctors have bills to pay, which is why they charge so much, if you cut the cost of those bills, lo and behold you will see a ripple effect in what you’re charged. (Also let’s not forget that another main cost of that doctors pass along to patients beside their obscene college debt is that they pay medical insurance…let’s make sure that insurance see the benefits of tort reform and crossing state lines).
(But I don’t see Trump working with getting rid of any subsidies…I mean he may want to start up Trump U again and get some of that cash.)
But part of the reason why doctors charge so much is because they know that Medicare and Medicaid aren’t going to pay them their full billing price, so to stay in business this has a threefold fix.
Adopt the Ryan Plan which will allow more competition in Medicare and Medicaid, which will both ensure doctors get better payment AND lower the cost to the taxpayer for these costs and ensure that there is no harm done to the the poor and elderly who need help.
(But that would be giving into Trump’s nemesis Paul Ryan, which means out of spite that will never happen)
In a second step we need to move as much of Medicare and Medicaid costs to the states as possible. While the private sector does better when done on large scale, government and bureaucracy work in the exact opposite manner. With only a few exceptions, the closer any government program is to the people the more efficient and the lower the cost. Lower costs mean that Medicaid and Medicare will be able to get closer to pay 100% of doctors’ asking prices for their services (not to mention more doctors taking Medicare and Medicaid patients) which means they will be able to drop their prices for the rest of us and still make a tidy profit for their practice.
(But that would mean giving up power, and the glorious leader will never do that.)
Increase the penalties for Medicaid and Medicare fraud. We’re talking about nearly $500 Billion in fraud every year. $500,000,000,000.00! I’ll let that number wash over you for a second. That’s one of the main reasons why Medicaid and Medicare can’t afford to pay full price to doctors. Now while I generally don’t believe the government should criminalize more things or come up with even stronger punishments, fraud is something even the most libertarian government must prosecute and fraud against the government doubly so. Penalties and enforcement need to be much stronger. If there’s $500 Billion in fraud it means the risk is much, much lower than the reward. Much lower. If we have to get a little Draconian, so be it, we need to make it very clear that the risk is now worth the reward.
Now the cost of drugs is also an issue. So how do we lower the costs of drugs (and liberals throwing money all willy-nilly at research never works).
(But that will mean actually punishing people for the kind of scams that Trump and his cronies love to engage in, so that’s not going to happen)
However, there are things we can do.
Allow drug patents to start when the FDA approves the drug. Right now a drug patent (20 years) begins when the drug is patented. So, when a drug takes 10-15 years to get FDA approval. This means that the company only has 5-10 years to recoup all of the cost of not only research for that drug, but of all the other drugs that failed. So, they have to recoup all of their investment for all R&D in only 5 years. And you wonder why the cost is so high. If we started the 20 year clock when the FDA grants approval they would have more time to recoup costs and thus would not need to charge as much.
(But Trump has already said he’s going to nationalize the drug industry, so we’re screwed there too.)
Reform the FDA. Right now the FDA prevents human testing of experimental drugs on willing patients with terminal diseases….because the drug might kill them. You know if I have a terminal disease the last thing I care about is if a drug will kill me, because I know for a fact the disease will. A lot of medical costs are in cancer treatment; to allow willing patients to try experimental drugs could not only rapidly speed up research (thus cutting costs to a fraction of their current levels) but actually find some cures and real treatments to one of the biggest costs in the medical industry.
And then there are some other things we could do that could help medical care. Nanny’s in the government like to talk to us a lot about eating healthier which is odd since government programs are designed to make sure we don’t eat healthier.
(But part of that reform would require more cooperation with the FDA’s counterparts in other nations…and in our bold new isolation that won’t happen.)
End all government subsidies, tariffs, and controls for agriculture. We pay people to grow tobacco, we pay them to grow sugar, we pay them to leave the ground fallow. We even pay people to grow corn only to be turned into fuel (ironically it takes over a gallon of fuel to produce a gallon of corn ethanol…that’s efficient.) When you subsidize something you get more of it. And you wonder why it’s hard to get healthy food. Yes, ending subsidies and tariffs on sugar would initially drop the price of sugar, but it would also result in less being produced which would again raise the price. It would also leave more ground for producing the fruits and vegetables we’re not getting right now because fresh food is so overpriced.
(Yeah I’m advocating free-trade with this one. I’m laughing right now as I type this while thinking that actual reform would require free trade, the thing Trump has vowed since day one to annihilate.)
Suggestion # 12
And while we’re at it, if we want people to eat healthier maybe we could stop regulations on food. Stop sending SWAT teams at raw milk distributors, stop fining people for having their own gardens of fresh food, stop preventing the Amish from taking fresh food across state lines. You know little things like that.
(Trump has promised to further militarize the police so this won’t happen either).
In opposition to his promise to keep preexisting conditions maybe we could do something actually intelligent. Pre-existing conditions cost a lot to insure, even more with the fact that Obamacare comes with a lot regulation about what you have to provide (which I’m guessing Trump also isn’t getting rid of those). It’s why insurers didn’t like having them on the books. Get a high-priced patient that has a higher chance of dying and never paying back the money you’ve spent on them. Please remember that insurance is a bet, the insurance company is betting they can make more money off your premiums than you will take out in treatment. That’s how they make money. If you have a preexisting condition then you have almost a 100% chance of being a loss. Any company would be stupid to take you on as a patient…unless we stated that people with preexisting you had to buy insurance in 30 year plans. You will pay premiums for 30 years no matter if you get better or worse, no matter if you die. Even if you die your estate still has to pay the premiums and the insurance company gets to be first creditor paid out no matter what. You pass a law that allows for plans like that then you become a good risk again for the insurance company, even if most people don’t have huge estates the numbers balance out over time. Add to that law the necessary options to allow buyouts of plans and transfers from one insurer to another and a lot of legal detail and then you once again have a free market system in insurance and everyone with a preexisting condition can still be covered.
(That would require a creativity of thought that neither Trump nor Congress has).
Suggestion #14 Or hey we could adopt Charles Murray’s UBI program which solves all insurance issues.
(But why would we do anything that effectively ends massive amounts of government power?)
So, that is more or less what a good destruction of Obamacare would look like for the first round of ending government interference in healthcare. Obviously, the devil will be in the details and there are myriad number of forms a good bill could have…but the fact is that such a bill would have to put more faith in the free market than Congress or the new President has ever shown. Thus, the likelihood we will get anything good is very low, and the likelihood they will just screw up the system more is very high.
And a special #15 for the states. Stop requiring ridiculous things on insurance plans. That’s why they cost so much. The more we can make insurance something only for major medical and then pay out of pock then the more we will be able to get costs under control.