Goodbye Obamacare? More like hello single payer!
Once Donald Trump enters office, Republicans will be in a good position to repeal Obamacare, something they have been foaming at the mouth to do for quite some time. Democrats might be able to filibuster to prevent an outright appeal, although the majority has other ways to gut the law, such as the reconciliation process.I say let them go ahead and repeal Obamacare without putting up a big fight. As Trump told 60 Minutes, "I am going to take care of everybody. Everybody's going to be taken care of much better than they're taken care of now." He also promised to provide "quality, reliable, affordable health care."I look forward to hearing the great ideas revealed by Trump and the Republicans in Congress. If they can do what they say then I'm entirely in favor of it and will give them the credit that's due.Meanwhile, I'm going to feel free to criticize the stock initiatives of the Republican party, which were largely mirrored in Trump's campaign statements:
- Repeal Obamacare, by which they really mean keeping the popular pieces like making health plans accept members with pre-existing conditions without charging higher premiums, but at the same time jettisoning the unpleasant aspects such as the individual mandate and taxes that help subsidize coverage. Sounds nice, but without a mandate, plans will suffer from adverse selection, premiums will skyrocket, and people will be left uninsured
- Let health plans sell insurance across state lines. This one is highly touted but in reality it's a big yawn. The plans themselves have little appetite for moving across borders and even if they did, most new entrants won't be able to establish strong enough negotiating positions in the markets to bring down premiums
- Change Medicaid to block grants so states can do what they want with the money. This isn't a terrible idea because it could allow states to more freely innovate and tailor Medicaid to meet local needs. In practice it's likely to be used just as a way to screw the poor
- Promote drug re-importation. Remember the senior citizen buses to Canada in the 1990s before Medicare Part D and the mail order pharmacies with drugs supposedly from Canada, that disappeared once Obamacare required drug coverage? Well, the GOP might bring these back. But the drug market has changed and the most pricey new meds won't necessarily be attainable from abroad anyway
- Let individuals who buy their own health insurance take a tax deduction the way businesses already do. Again, sounds great in theory but it's a regressive approach that rewards higher income people who are in the top tax brackets. It also encourages premiums to rise and widens the budget deficit. The Cadillac tax or some variant that limits deductibility by businesses is more fiscally responsible
- Expand Health Savings Accounts (HSAs), allow them to be shared among family members and passed on as part of one's estate. Not a bad idea but hardly a game changer in its own right
Remember, thought, that the Republican ideas above were presented by conservatives, while Trump himself has been at least a liberal and frankly more of a socialist when it comes to health care policy, at least based on his earlier writings. Once he learns that the ideas of the conservatives in Congress won't produce universal coverage, he may well go back to improving --instead of replacing-- Obamacare, moving to a Canadian style single payer system, or opening up Medicare for all, just like Bernie and much more radical than Hillary.I can't wait to see how it all plays out.
Image courtesy of Thanamat at FreeDigitalPhotos.net
By healthcare business consultant David E. Williams, president of Health Business Group.