Posted on 01/16/2017 8:57:02 PM PST by Tolerance Sucks Rocks
Thursday, I laid out the case for why Obamacare should be repealed, instead of propped up and tinkered on by additional top-down, boardroom thinking. It’s clear that whatever replaces Obamacare must focus on quality and incremental local solutions, not one-size-fits-all government mandates.
In this respect, the federal government’s biggest task for replacing Obamacare is to get out of the way and let state policymakers and health care providers innovate.
First off, let’s get clear what Americans want: They’d like many choices of affordable health insurance plans that allow them to choose their doctors. They want to buy a plan when they are young, then keep their plan from job to job and into retirement. And they’d like it to be truly affordable. These “must haves” are obvious to people of any political orientation.
Instead of approaching this challenge like designing a single system or product (the way Obamacare was constructed), Congress needs to help these conditions develop organically, while preserving freedom of choice for Americans. Here are some further thoughts.
Expand health savings accounts. As we age, our need for medical care increases, yet current government policies offer few incentives for people to save for their future health care needs. The one exception is health savings accounts, which are tax-deductible accounts owned by individuals that roll over from year to year. But those accounts are currently available for just one type of insurance plan—a high-deductible plan.
The improvement would be to expand the scope of health savings accounts so that they can be used with any type of insurance design, as well as to become the accounts into which any funds (either private or public) to help pay for health care needs can be deposited. That way, people would not only have more options, but also a place to keep (for future needs) any savings they get from buying better value insurance and medical care.
Create space for diverse payment models. Congress should remove regulatory obstacles to innovative approaches to providing or paying for medical care. For instance, many direct primary care practices use a monthly subscription payment model instead of the traditional fee-for-service model. This model eliminates significant administrative costs and allows doctors to spend more time with patients. Yet federal and state regulations that inappropriately treat those payments as insurance (as opposed to payments for medical care) further inhibit adoption of this approach that simultaneously reduces costs while improving quality.
Allow innovative new delivery models. In a similar fashion, federal and state lawmakers should remove the regulatory obstacles to other health care delivery innovations, such as specialty hospitals, free-standing emergency rooms, and telemedicine. Indeed, too often those regulatory barriers exist not to protect patients or consumers, but rather to protect less efficient providers from competition.
In general, federal health policy should focus on establishing a few basic rules while leaving most of the detailed decisions to either the private sector or state governments.
For instance, any federal tax relief for health care expenses should be the same regardless of a person’s employment situation. Today, those with employer coverage pay no income or payroll tax on their health insurance benefits, but those purchasing coverage on their own have to use after-tax dollars to buy coverage.
In addition, those who rely on public programs should be able to take the value of their benefits in the form of a contribution that they can apply to the plan of their choice, not dumped into a one-size-fits-all government program.
The federal government should also return to the pre-Obamacare status of setting only minimal rules for insurance markets and deferring to state regulation of insurance as a financial services product.
The federal government should not attempt to design and manage America’s health care system. Federal laws and regulations should allow and encourage insurers and medical providers to compete in offering better quality care at lower costs.
This will require returning health care decision-making to patients and their doctors, and returning policymaking to the lowest level of government that is best equipped to handle it: state legislatures.
Some politicians don’t like the idea of relinquishing that power, but after seeing the results of decisions made in Washington over the last few years, I think it’s worth a try.
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PING!
I am afraid that the socialists won on the 0bembacare socialized medicine situation.
Even Trump is talking ‘replacement’ after repeal. Replacement can mean only yet another socialized medicine situation.
The only ‘cure’ is repeal, period, and let things go back to the way they were before 0bembacare.
After ‘repeal-and-replace’ the socialists will smile and inwardly say, “We did it to them again!”
Telemedicine has tremendous potential. Consider that smartphones are now coming on the market that contain sophisticated sensor packages that can not just take vitals, but can chemically analyze breath and saliva for telltales of disease. All this could help identify illnesses earlier and reduce the cost of treatment.
It should be possible for anyone to audio/video chat with a healthcare professional from their computer or smartphone. Add the sensor-equipped phone and simple bluetooth-linked weigh scales and other sensors and a person’s vital signs and key medical information would all be available just as if they were sitting in a medical office.
Urgent-care and ER sites will always be needed, but increasingly companies like CVS and Walgreens want to invest in creating these in-store, and in paying at least part of the staffing cost.
Whatever the final bill is, it has to be better than the Unaffordable Care Act, which, I believe,, was produced by 100 semi-sentient simians in a roomful of typewriters.
I think they need to grandfather those with pre-existing conditions and set a deadline. Turn insurance back into insurance or we’ll never get the cost down.
bump for later
They still don’t get it.
Yes to repeal and no replacement.
Repeal immediately and then 18 months to replace under market conditions. Just in time for the 2018 elections.
No, DeMint doesn’t get it.
Trump seems to have the right approach.
Too many on our side, are advocating for just dumping Obamacare. Not remembering, that before Obamacare, our system was already a mess.
Nobody is seeming to recognize, the reason it was created in the first place, is because our healthcare system is monumentally expensive, prohibitive to enter, and doesn’t cover nearly enough.
Those are significant issues. Yet nobody fixed them, for years, and years, and years.
The GOP did nothing.
The Democrats did nothing.
Nobody did anything. For a long, long time.
Finally Obamacare was a result, of the big, big problems our healthcare had.
Now granted it was itself, a whole new set of problems, but it was something.
When we repeal Obamacare, we NEED to replace it so everyone is covered.
We spend far, far to much on healthcare, to leave anyone not covered.
It is irresponsible to do so.
Completely.
Politicians are experts at bait and switch. When the American people started making noise about unchecked illegal "immigration" and calling for immigration reform, the politicians immediately took up the cause of immigration reform. Except, instead of making the laws more conducive to suppressing illegal "immigration", the politicians started adding benefits and rewards to illegal aliens. In other words, the politicians took the American people's demands and used them as a cover in which to push their agenda.
While the tactic has been used against Americans, the old bait-and-switch can be used for us. The Democrats are demanding a "replacement" to Obamacare, one which is just as onerous and expensive as what it replaces. Trump and Republicans in Congress can keep talking about replacing Obamacare, while in fact, they are working to not just get rid of it, but to institute some of the common-sense reforms that have been needed for ages.
What do you mean by "the way things were before Obamacare"?
Obamacare, and Romneycare before it, were able to be passed because of a problem. That problem was caused by Federal legislation passed between 1965 and 1986, which by promising unlimited hospital, physician, and R&D services without cost to those unable to pay and without on-budget appropriations from Congress was slowly destroying the actual budget, the credit of the US, and our ability to govern ourselves.
Of course, Obamacare took the form it did because of who the Democrats are. It's ironic to call it "Obamacare", since Obama had almost nothing to do with its design. That plan, or something quite like it, has existed on the word processors of the Left since I went to medical school in 1972. In fact, when my Dad went to medical school in 1944, they were already talking about something along those lines.
They've built a very clever trap. And the cleverest part was getting people to believe that the essence of Obamacare is reversible, when it is not. What existed before has been destroyed, and it cannot be re-created.
I expect Trump will nationalize the system within a few years, maybe even by the Fall.
If we really want to fix healthcare we need to be ready to do the following:
1) get the lawyers out. Defensive healthcare is expensive.
2) get the insurance companies out. The paperwork adds much expense
3) bring pharmaceutical prices in line with the rest of the world
4) bring physician wages in line with the rest of the world
5) get healthcare administration costs under control
6) make patients accountable for their health.
obviously, I have just listed all the powerful lobbies in America.....
Last night, Tucker Carlson was pushing drug reimportation.
Repeal the Kennedy healthcare act from the 1960s as well. It helped create a lot of the problems that 0bamacare was supposed to solve.
Repeal, don’t replace.
Agree.
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