Monday, July 18, 2016

RNC - Trump Positions "Healthcare Reforms"

In this series of posts regarding Donald Trump's actual positions, this one will be one where I actually find a lot of common ground with the orange man.

The biggest item that I applaud is making health insurance fully deductible under the US tax code for all individuals. This is an idea that will provide meaningful tax savings, especially for employees of companies that refuse to provide healthcare benefits. Due to the vagueness of many Trump positions, I am left to speculate how this would happen. I hope he would make health insurance an adjustment from income like health insurance is for the self-employed. However, even making it an unlimited itemized deduction would be a great change.

Other items I agree with include:
  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 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.
 The individual mandate is something that was reprehensible. There are many American's who know their annual health care costs and are quite capable of budgeting accordingly. Granted, emergencies arise. However, that should only mandate cheaper catastrophic coverage requirements at most instead of the more expensive plans required by ACA. The power of the purse for healthcare decisions should be with individuals (with a possibly a catastrophic individual mandate at most).

I'm not sure if this will make all the difference, but removing interstate barriers for health insurance purchases can only help reduce costs. Last but not least, HSA's were a wonderful tax savings device created in the Bush years that was all but destroyed with Obamacare. I love the idea of making them effective tax savings engines again.

The items I don't care for include:
  1. 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.
  2. 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.
  3. 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.
The first item seems to be a hint at keeping some of the bureaucracy that opponents of Obamacare hate. Many MD's and mid-level providers will complain that the over-reach of Obamacare into their work has reduced their ability to focus on the patient in order to satisfy bureaucratic requirements of the ACA. This price transparency requirement seems like more of the same overreach.

Medicaid before Obamacare had a sharp-cliff where recipients lose all benefits if there income exceeded a very small sum of income. I believe sharp benefit cut offs are a disincentive to work for many welfare recipients and that the current system gives recipients some breathing room to get into the work-force, gain experience, and increase their income until they can get jobs with solid benefits and income.

That last item that I disagree with is the idea of removing barriers for drug providers. Barriers in the pharmaceutical industry keep drugs safe. Even with the barriers we now have, drug providers have the guarantee of suits and paying damages for issues with side effects. Considering who is making this recommendation, gives me pause as well. "Who wants Trump chemo?"

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