Tag Archives: Obamacare

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.

Trump’s Actions Show that Change is Messy

 

The election of 2016 was billed as a “change election.” It is clear now that a large portion of the electorate had reached such a level of frustration and feeling of disconnect with the status quo that they were willing to vote for change – any change. Even though they came from different sides of the political spectrum, Donald Trump and Bernie Sanders were the only presidential candidates to recognize and tap into this powerful undercurrent of the desire for change.

Unfortunately for Sanders, his message of change was blunted by the Democratic National Committee that had effectively rigged the party nomination in favor of an establishment status quo candidate. On the other hand, Trump benefited from the fact that, while the Republican National Committee favored establishment candidates, a gaggle of 15 other candidates diffused the establishment support. This allowed disaffected Republican voters to coalesce around Trump’s message of change. Even though Trump never received a majority of Republican primary votes, the concentration of voters driven by the desire for change pushed him to the nomination.

The same phenomenon (plus a little help from Russia) also impacted the general election. Even though Trump and his message of change failed to garner a majority of the popular vote, he was able to cobble together enough disaffected voters to flip a number of traditionally establishment Democratic states in order to win the majority of Electoral College votes (the votes that really count) and win the presidency. Much to the chagrin of the bulwarks of the government establishment status quo – the mainstream Democratic and Republican parties and the national media.

Learning the Lessons of Change Management

As president, Trump is now challenged to live up to his promise to be a change agent. He is quickly learning the lesson that any person in a position of leadership who seeks to bring about change must understand: Change is not something that is simply announced, it has to be created.

Change has two natural enemies: Those who resist change and those are frustrated by the status quo, but fear what change will bring. Those who are comfortable with the way things are and view change as a threat to be resisted. For them, change is the answer to a question they never asked. Ironically, those who most vociferously call for real change can become fearful of change when the answer to what change means is not clearly answered. As a result, change, no matter how beneficial it may ultimately be, is always difficult to implement and accept. And change becomes downright messy and chaotic when what is to replace the status quo is muddled or nonexistent.

Real change is about being positive, not negative …

For a leader to be a successful change agent, it is critical for them to shift the focus off the desire for change itself and focus on the benefits that will be derived from change. In other words, for followers to accept change, the debate should not center on what they are losing, but on what they can gain from the change. If that does not happen, change will be stillborn.

A good example of this change dynamic at work is the current debate over Obamacare. From its inception, the majority of Americans have had a negative opinion of the program. The Republicans seized on the unpopularity of Obamacare to promise that if given the power to act, they would “repeal and replace” it. Likewise, during the campaign Trump railed against Obamacare and promised that his first act as president (right after tearing up the Iran nuclear agreement) would be to repeal and replace Obamacare.

But now with the Republicans in full control of the government, the effort to deliver on the promise of repealing and replacing Obamacare has become, at best, messy and chaotic. Even the Republicans are fighting among themselves as to how to implement this change. There is no clear, coordinated plan being offered by Trump or the Republicans; despite the fact that they have had years to develop one.

As a result of this befuddling Republican approach to change, even those who disapprove of Obamacare have begun to have second thoughts. For the first time in years, public opinion polls have shifted and more people approve of Obamacare, than oppose it.  

Why is it that even those who were demanding change (and voted for it) are now uneasy with change? The problem is – and this is a great lesson for any leader to learn – that by simply announcing the intent to repeal Obamacare and not coupling it with a clear plan for going forward, Trump and the Republican leaders have allowed people to focus on what they will be losing (as bad as it may be) rather than on what they will gain by a new approach to healthcare. 

What Trump and the Republican leaders are missing in their effort to implement the promised change (not only for Obamacare, but other issues as well) is the understanding that while people may be frustrated with the status quo and claim to want change, they are even more fearful of an uncertain future. As a result, there is nothing but confusion, frustration and fear of what the change will bring.

Again, the key to effective change management is for the leader to focus on where they are going, rather than where they have been. No matter how much people may protest against the status quo, unless they clearly understand the benefits of the proposed change, they will resist the change.

For example, Trump and the Republican leaders could have said something like, “We are going to repeal Obama care and replace it with an expanded Medicare system that would be available and cover all Americans.” By offering an alternative to the status quo, rather than simply attacking it, leaders can marshal support needed to make change positive.

Living with change …

There is a good lesson here for anyone who seeks to implement change in an organization. No matter how passionate people may be about seeking change and especially for those who do not recognize the need for change, the best approach for gaining acceptance of change is to debate the future, not the past. It is the duty of the leader to paint that future and explain the benefits to those who will live it. Only that way will real change come about.

Trump Should Focus on Replacing Obamacare

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A cornerstone of Trump’s campaign for president was the promise he would repeal and replace Obamacare. And rightly so, because Obamacare is an unmitigated failure. The promise of Obamacare was to provide “patient protection and affordable healthcare” for some 40 million uninsured Americans. The plan has failed on both points.

The saga of Obamacare is a great example of wanting to do the right thing, but going about it the wrong way. Obamacare as we know it came about because President Obama capitulated to the merchants of the devil – the health insurance industry – in order to strike a deal on healthcare reform. The great myth surrounding Obamacare is that it is some type of government provided healthcare coverage like Medicare, but it isn’t. Under Obamacare the government has nothing to do with the type of coverage offered, the quality of the services provided or the cost consumers pay for healthcare; that is all left up to the whims of private health insurance companies.

Obamacare is nothing more than a (clunky, complicated) website that is intended to match-up those who need healthcare coverage with private, for-profit insurance companies looking to sell their policies. The only requirement for insurance companies to market their policies on the “exchange” is that pre-existing conditions are covered and children can be included under the policy until age 25. Beyond that, insurance companies are free to determine the structure of the policies, the provider networks the insured must use, deductibles and the co-pays – the amount the insured must pay out of pocket; and those can run as high as 40 percent of medical charges. Most important, the insurance companies are free to charge any premium they desire and increase those premiums at will. In short, Obamacare has become nothing more than a profitable boondoggle for insurance companies. As usual, the ones left holding the short end of the stick are individuals who most need and can least afford healthcare coverage.

In addition, employers who are mandated to provide employees with healthcare coverage are free to use all sorts of machinations to avoid this responsibility. (For example, hiring employees as part-timers and making sure they work less than 40 hours a week.) This forces the employees to use the Obamacare website and be pillaged by the insurance companies.

Be careful what you wish for …

With a Republican soon to be in the White House, the Republicans in Congress who believe healthcare is a privilege based on the ability to pay, rather than a right of citizenship, are stupid-drunk giddy over the prospect of killing Obamacare, but they need to be careful what they wish for. There may be one problem that could turn their dream into a nightmare. While that Republican soon to be in the White House has savaged Obamacare, he has consistently supported the rights of every American to have healthcare coverage. Over the years Trump has repeatedly praised the concept of universal healthcare.

On 60 Minutes Trump said, “Everybody’s got to be covered. This is an un-Republican thing for me to say because a lot of times they say ‘No, no, the lower 25 percent that can’t afford private.’” He continued, “I am going to take care of everybody. I don’t care if it costs me votes or not.”

On the Larry King Show Trump bluntly proclaimed, “If you can’t take care of your sick in the country, forget it, it’s all over … I believe in universal healthcare.”

In his book The America We Deserve Trump wrote, “We must have universal healthcare … I’m a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses …”

So the Republicans in Congress may be in for a bit of a surprise blowback from their Republican president when it gets down to the nitty-gritty of repealing Obamacare, without offering a reasonable alternative for millions of Americans who lack access to healthcare or don’t have the ability to pay the exorbitant premiums charged by private insurance companies.

What is the alternative that Trump could propose?

If Trump is sincere in his belief that all Americans should have affordable access to basic healthcare services, he could achieve that goal by simply expanding the scope of two healthcare plans already in existence – Medicare and Medicaid. Medicare provides effective and efficient medical care for millions of Americans age 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 in point of fact are paying for the healthcare provided by hospitals, care givers and doctors for millions of Americans. Patients are free to select any of the 95 percent of hospitals and doctors who accept Medicare payments to provide their care. This is not the government deciding or providing the healthcare, but simply being the “single payer” of the benefits provided by private hospitals and doctors.

So the question is: Why not repeal Obamacare and replace it with the two national healthcare programs already in existence and functioning effectively? There is no need to create an entirely new bureaucracy. The simplest and most direct way to offer basic healthcare to all Americans at affordable costs is to expand and enroll everyone – at all ages – into Medicare or Medicaid.

Of course, this can’t be done with a flip of a switch, but an organized national phase-in of Medicare over time could make it happen. For example, in the first year those 60 to 65 would be eligible for Medicare, then the next phase would include those 50 to 55, and so on until everyone is covered. This would allow for Obamacare to be repealed and phased out at the same pace Medicare is expanded.

This approach could be a win-win for everyone. Trump and the Republicans could fulfill their campaign pledge to repeal Obamacare; Trump could remain consistent in his call for universal healthcare 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.