Tag Archives: Healthcare

WHY OBAMACARE CAN’T BE FIXED AND WHAT SHOULD BE DONE ABOUT IT

from “If You’re Not Making History, You Are History” by Bob MacDonald

After seven years of bombast and bluster, the Republicans have shown they have no idea how to repeal and replace Obamacare. The problem for Republicans is that they were trying to fix the wrong thing. The misnomer is that Obamacare is a government healthcare plan. It is not. Medicare and Medicaid are government health plans, but Obamacare is nothing more than a government sponsored effort to help an insurance company market policies to individuals who do not have access to healthcare; either from their employer or an existing government program. (About 10 percent of the population.) Obamacare also expanded an existing healthcare system — Medicaid – in order to provide coverage for millions of low income individuals who could not afford private policies, under any conditions.

To achieve its primary objective, Obamacare created an “exchange,” in the form of a government website for insurance companies to list and market their policies. It is much like Amazon where companies list the products they want to sell and consumers go online to buy them. Obamacare is not government insurance, but rather private insurance offered on a government website.

In order to list their policies on the “exchange” insurance companies had to agree to issue coverage to anyone who applies, regardless of their current health or pre-existing conditions. In addition, companies could not put a “cap” on the size of any claim and (unlike most private policies) they had to offer expanded coverage for preventive care, mental health and substance abuse treatment.

This was all good for the insured, but the insurance companies – that are after all in business to make a profit – blanched at these costly requirements. The insurance companies argued that such requirements were not “actuarially sound” and, in fact, guaranteed losses, regardless how much premium was charged.

In response, the government made two promises to the insurance companies: Everyone who did not have health coverage from another source would be “mandated” to buy a policy. This would “spread the risk” and create stability. (Not everyone who bought a policy would have a claim.) In addition, the government guaranteed to reimburse the companies for any losses they might incur by participating in Obamacare. (What company would not want to participate when the government did the marketing of the policies and guaranteed to cover the losses?) Beyond that, the government agreed to subsidize premiums for those who could not afford what the companies were charging.

So what was intended to be a simple process of connecting customer and company to provide individual health insurance via the Internet turned into a complicated, confusing and cumbersome plan that satisfied no one. While it is true that since the inception of Obamacare over 22 million previously uninsured Americans have been able to access health coverage, the vast majority of the newly covered resulted from the simple step of reducing the bar for lower income and the poor to be covered under Medicaid.


Those opposed to Obamacare argue that it is in a “death spiral” and that it will soon collapse. They point to escalating premiums and suggest the individual market is melting down because more and more companies are withdrawing from Obamacare. They are right about all this, but it is a man-made not structural problem. Ever since the Republicans took control of Congress and now the White House, they have been threatening to repeal the “individual mandate,” eliminate subsidies to individuals and de-fund the government’s promise to subsidize insurance company losses. Insurance companies need market stability to properly price the policies to make a profit, so no wonder that under these threats they are withdrawing from Obamacare. (How many companies would continue to offer their products on Amazon if Amazon had requirements that guaranteed losses with each sale?) Because of the uncertainty of the rules going forward, insurance companies have only two options: significantly increase existing premiums and refuse to issue new policies.  

REPEAL AND REPLACE OBAMACARE

Obamacare was never the best way to assure that all Americans, regardless of their income or status in life, receive basic healthcare. And there is a better way to achieve this objective, without having to reinvent the wheel. It is a proven solution that is right in front of us.

Medicare and Medicaid have provided millions of Americans with efficient and effective healthcare for decades. If the objective is to assure all Americans – regardless of income or age – the right to basic healthcare coverage (as it should be) the simplest, most effective and least expensive way to do so is by merging Medicare and Medicaid into one program that could provide basic healthcare for all Americans from birth to death. This could not happen overnight, but it could be phased in over the next decade.

Critics argue that the cost of such an approach would be daunting, but by basing premiums, deductibles and co-pays on the basis of means and by diverting monies expended in the current patchwork health care system, the costs would not only be manageable, but less than what is being spent now. Besides, if we can spend $2.4 trillion on wasted wars in Iraq and Afghanistan shouldn’t we be willing to invest in the good health of all Americans? Such a program of universal healthcare would not be “government provided” care, but rather government payment for the services of private providers; just as Medicare and Medicaid do today.

It may surprise you that one well-known politician has long favored this approach to healthcare. In his book The America We Deserve he wrote, “We must have universal health care… Our objective should be to make reforms for the moment and longer term, to find an equivalent of the single-payer plan …” In multiple interviews and public comments over the years he has consistently endorsed the right of all Americans to receive basic health care coverage. In February of this year, he praised Australia’s health care system, saying to the Australian prime minister, “You have better health care than we do.” Of note is that Australia has a universal health care plan that is modeled after American Medicare and even called Medicare. Of course the individual referred to here is none other than Donald Trump.

Medicare and Medicaid provide access to efficient, effective healthcare for millions of Americans, so rather than constantly haggling over fixing failure, why not build on the proven success of established programs that could provide healthcare for all Americans?

Trump is Right: Healthcare is Complex, but it does not have to be

from “If You’re Not Making History, You Are History” by Bob MacDonald

 

No doubt about it, the healthcare system in America is a mess. Obamacare is not working as intended and the proposed Republican replacement is being castigated, even by Republicans, as potentially even worse. Democrats complain the American Health Care Act (ACA) takes too much away from people who need coverage the most. Republicans who oppose the ACA call it “Obamacare-lite” and complain it does not go far enough to repeal Obamacare; and that it creates an entirely new entitlement program.  

The reality is that resolving the healthcare challenge is simple, but it is made complex because Republicans and Democrats have diametrically divergent views on what the end result should be. In simple terms, the Republicans believe the answer lies in assuring that all Americans have “access” to healthcare coverage, while the Democrats believe the answer lies in assuring that all Americans actually have healthcare coverage. There is a big difference between having access to healthcare coverage that an individual needs but cannot afford and providing the needed coverage, regardless of the ability to pay.

This difference exists because the political leaders have failed to address and resolve the most fundamental healthcare question: Is basic healthcare a right or a privilege?

The Republicans believe that healthcare is a privilege, and thus, so long as there is universal access to healthcare coverage (no matter what form or price), the problem is solved. (It should be noted that prior to becoming president, Trump consistently argued that healthcare coverage is a right.) On the other hand, Democrats take the position that every American citizen, regardless of financial status, has a right to receive basic healthcare.

It is this philosophical difference that motivates the Republicans (believing healthcare is a privilege) to propose in the ACA that Medicaid (the state/federal plan that covers low income citizens) funding be slashed. (This is one of the chief reasons why the Congressional Budget Office estimated that as many as 24 million Americans will lose their coverage under the Republican plan.) Conversely, (believing that healthcare is a right) the Democrats used Obamacare to expand Medicaid that covered 15 million people who previously could not afford coverage of any type.

There can be no effective bipartisan agreement on the best form of a healthcare system, unless or until there is a debate and resolution of the question as to whether healthcare is a basic right of every American citizen or a privilege based on means to pay. If, as a society, we decide that healthcare is indeed a privilege, then the Republican ACA plan will work just fine. If, we as a society decide (as virtually every other industrialized nation has) that basic healthcare, like a basic education, is a natural right of every American citizen, then we can work together in a bipartisan way to find the best way to achieve that goal.

Repeal and Replace Obamacare

Ironically, if it is decided that healthcare is a basic right, it would call for the repeal and replacement of Obamacare, because it has failed to achieve the objective of covering all Americans. But such a replacement would be based on the rights of all, rather than the privilege of a few to have healthcare.

If this approach to repealing and replacing Obamacare is taken, the solution is right in front of us. It is a healthcare system already in operation. It has proven to be effective and efficient; it has high consumer satisfaction and acceptance. Maybe even more important, it is a plan that President Trump has endorsed and pledged to protect.

Taking the complexity out of the healthcare solution.

The simplest and most effective way to solve the healthcare crisis is to merge the Medicare and Medicaid systems into one program that, on a phased in basis, will provide basic health care services to every American citizen, regardless of age, social status or income.

There would be no need to create another bureaucracy. Both of these programs have processes and procedures in place and in point of fact are paying for the health services provided by clinics, hospitals and doctors for millions of Americans age 65 and over, along with millions more of low income citizens. Patients covered by Medicare are free to select any of the 95 percent of the doctors, clinics and hospitals that accept Medicare payments. This is not the government deciding or providing the healthcare, but simply being the “single payer” of the benefits provided.

Of course merging and expanding Medicare and Medicaid into a universal healthcare system can’t be done with a flip of a switch, but an organized phase-in of this system over time for those not currently covered under Medicare or Medicaid could smooth the way. This would allow for Obamacare, along with all other forms of healthcare such as individual and employer group plans, to be repealed and phased out at the same pace the new system is expanded.

Certainly there will be concerns about the cost of such a change, but a number of serious studies have concluded that diverting all expenditures on the current system (federal, state, individual and employer) toward this new system and combining this with premiums, deductibles and co-pays based on income, would create more efficiency and actually be less costly than the current system. President Trump has even made this point in interviews.

Using this approach to fixing the healthcare system could be a win-win for everyone. Trump and the Republicans could fulfill their campaign pledge to repeal and replace Obamacare; Trump could remain consistent in his call for universal healthcare and his pledge to protect Medicare and, most important, all Americans could finally join the millions of citizens of every other industrialized nation in the world for whom basic healthcare is a right of citizenship, not just a privilege for the wealthy.

Repeal Obamacare!

(AP Photo/Alex Brandon)

 

There is no doubt that The Patient Protection and Affordable Care Act — AKA Obamacare – has failed to achieve its most fundamental objectives. The primary goal of the legislation was to make health insurance available to all Americans, with the parallel promise that this health care would be affordable. Obamacare has failed on both points and is so flawed it should be repealed.  

While 17 million Americans have been added to the rolls of those insured, there are still over 25 million who remain uninsured. Furthermore, those who have been able to obtain medical insurance are finding that the coverage is anything but affordable. Once the newly insured are signed-on, the insurance companies (unencumbered by regulation) are systematically raising the cost of coverage by as much as 30 to 50 percent annually.

There are (at least) three reasons for the failure of Obamacare: 1) Obama was willing to give up on principles in order to get any law passed. 2) To gain their support, insurance companies were allowed to participate in the design of the plan in a way that would benefit them financially. 3) The Republicans were unwilling to support any plan that would guarantee insurance coverage for all Americans.

The problems with Obamacare remain unresolved because it has become no more than a ball in a political rugby scrum. The plan’s supporters – mostly Democrats — are struggling to find ways to fix the unfixable, while Republicans remain fixated on blanket repeal. Both of these approaches to Obamacare talk at the problems but fail to offer real solutions. Have you noticed that one group is not complaining about Obamacare? That would be the insurance companies, because they are too busy piling up huge profits from Obamacare.  

As a general proposition, the Republican Party believes that medical care is a privilege not a right. They believe all Americans should have all the healthcare they need and want, just so long as they have the resources to pay for it. As a result, every single GOP presidential candidate’s position on healthcare starts with repeal of Obamacare, but none of them offer even a hint of an alternative. Can you just imagine the chaos and confusion that would ensue in the health-care arena if Obamacare was simply repealed and no viable alternative was available?  

The Democrats, on the other hand, act as though the “right” to have healthcare coverage means that it should be free; as if there was no real cost involved. Can you just imagine how costly and confusing healthcare will be if Obamacare is allowed to continue down its current path?      

The good intentions and objectives of Obamacare were admirable, but for reasons outlined above, the design and implementation of the plan were both botched and it is beyond repair. The longer Obamacare is allowed to stumble down its current path, the more costly and inefficient it will become.  The goal of insuring all Americans at affordable cost will never be met. The Republicans are right – Obamacare should be repealed. But the Republicans are callous and dead wrong to suggest that the healthcare – or lack thereof – for millions of Americans should be left to the caprices of the insurance companies, driven by profit alone. Does it seem fair to you that an individual’s access to reasonable healthcare should not be determined by the weight of their wallet?

There is a Better Path to Healthcare for all Americans

Already in place, time-tested and working effectively (as any government program can) are the Medicare and Medicaid programs. Medicare provides effective and efficient medical care to millions of Americans 65 and over. Medicaid – a combination of state programs funded by the Federal government – provides medical care to millions of low income individuals.

The point is that these two programs have processes and procedures in place and are in point of fact administering healthcare (from private hospitals and physicians) for millions of Americans, but not for all. So the question is: Why not repeal Obamacare and replace it with the two national healthcare programs already in existence and functioning effectively? The simplest and most direct way to offer all Americans basic healthcare at affordable costs is to expand and enroll everyone – at any age – into Medicare or Medicaid.

This can’t be done with a flip of the switch, but an organized expansion phase-in over time could make it happen. For example, in the first year those age 60 to 65 would be eligible for Medicare, then the next phase would include those 55 to 60 and so on until everyone was covered.

Of course, adjustments and changes would have to be made to both systems, but these would be more administrative and cost-control measures. For example, premiums and deductibles for coverage could be adjusted based upon income or wealth. There is no reason why someone making $1 million a year should pay the same premium or deductible as another making $50,000.

There is not space in this blog to delineate all the adjustments that would be required in order to make Medicare and Medicaid work for all Americans, but they are more administrative in nature and don’t go to the core of the programs. Ultimately the Medicare and Medicaid programs could be merged. The point is that we have two time-tested and functioning programs providing healthcare for millions of Americans, so why not just do the right thing and expand them to include all Americans?

Can Everyone be Happy?

Of course not everyone will be happy with these changes, but when is everyone ever happy with any action?

The Republicans are going to have to disabuse themselves of the belief that health care is a privilege and not a right. They accept basic education as a right, why not basic health care? Aren’t both of those part of the Constitutional right to “life, liberty and the pursuit of happiness”? The reality is that of the 47 largest industrial nations in the world, the United States is the only country that does not consider basic health care as a fundamental right of its citizens. But Republicans can be happy too. They can take credit for repealing Obamacare and swallow the expansion of Medicare and Medicaid. After all, every Republican president since Nixon has accepted and expanded Medicare and Medicaid. 

The insurance industry will certainly not be happy. So what?! The insurance companies have had a free-hand to provide health insurance for Americans for over 50 years. They have done a miserable job. If you had lots of money and were in good health, you could buy all the health insurance you wanted. But woe betide the individual who was poor or had a preexisting condition. Besides, the insurance companies could make a ton of money selling supplemental policies (as they do today) that pay the deductibles for Medicare, or for extra care not covered by Medicare.

The hospitals and doctors will not be happy. Don’t be so sure. I have hear many hospital administrators and doctors complain about Obamacare, but I have never heard any complaints about Medicare. Sure, they will complain about Medicare’s attempt to control costs and for not reimbursing the hospital or doctor for what they want to charge for their services. But have you ever heard of a hospital or doctor going bankrupt because Medicare or Medicaid didn’t pay enough for the services they provided?

And the Moral of the Story …

If we (as we should) want to provide effective, affordable healthcare for all Americans – despite age or resources – we have to recognize that, for all its good intentions, Obamacare is not the answer and it should be repealed. Doing nothing or “letting the market determine” who gets coverage is not the answer, either.

But the answer in right in front of us. Medicare and Medicaid has worked for millions of Americans and with just a little effort we can repeal Obamacare and replace it with these systems that have proven to work. So?