President Trump may well be the right person at the right time to transform our health-care system. He has a unique opportunity to take charge and move the conversation from “repeal and replace” to a system where Americans can get quality, affordable care when they need it.
Health care in the United States has been failing for decades. We constantly spend more and get less. Health care consumes an ever-increasing and unsustainable share of our gross domestic product. Americans cannot afford health insurance. Care is increasingly hard to access.
The Affordable Care Act, colloquially known as Obamacare, was supposed to fix all this. It made things worse. Previously unaffordable insurance premium costs went up, not down. Obamacare drove insurers such as UnitedHealth, Aetna, and Anthem out of the market. Tens of millions of sick people signed up for “free” Medicaid insurance while the healthy (and therefore low-cost) “young invincibles” did not. Now, fewer and fewer doctors can afford to accept the low ACA payments.
In short, Obamacare insured more people at higher costs with fewer doctors to care for them. It also destroyed almost 3 million private sector jobs in the process and resulted in the hiring of tens of thousands of health-care bureaucrats. They get paid (by you), but doctors don’t.
Repeal and Replace Isn’t Going So Well
Between 2012 and 2016, the Republicans tried unsuccessfully to repeal Obamacare 52 times. Now, Republicans control both Houses of Congress and promise to fix health care through “repeal and replace.”
Senators Bill Cassidy (R-LA) and Susan Collins (R-ME) are proposing what they claim is an Obamacare “replacement plan” called the Patient Freedom Act of 2017. The bill purports to give states control of health care but curiously provides that states can “keep Obamacare” if they wish. Obamacare is, by definition and action, federal control of both supply and demand of health care insurance, goods, and services. The Cassidy-Collins plan is neither repeal of Obamacare nor is it replacement. The bill fails to empower the people, as the new president promised in his inaugural speech.
Unfortunately, like this bill Republicans’ various planned repeal proposals appear only to be partial. Using the budget reconciliation process, they plan to cancel aspects of Obamacare that affect the federal budget, such as subsidies, risk corridors, bailouts, the individual mandate, and possibly even the 12 new taxes.
This may seem like good news for our wallets, but if they leave the regulatory scheme intact, the result will be disaster. It will leave in place federal eligibility standards, verification processes, and benefits packages that are devastating both state budgets and insurance company bottom lines.
We Need a Fresh Start
There is talk that budget reconciliation is the only way to get to repeal, but it’s not, and anything short of a fresh start will leave us erroneously focused on managing insurance coverage rather than enhancing the availability of timely, affordable care.
America is the richest, most powerful, and most innovative nation on earth. Americans ought to have the best health-care system. We clearly do not. We have great doctors and nurses who have no time for us. They produce daily medical miracles we cannot access or afford. In other words, we have superb health-care system components and a lousy health care system.
Who created our health care system? Who has continuously “fixed” that system into its current moribund condition? Washington. The root cause of our health-care system failure is federal control of health care. Since federal control is the root cause, take away that control to cure sick health care.
Trump Can Do This
From his campaign slogan of “draining the swamp” to his inaugural speech, “We will no longer accept politicians who are all talk and no action, constantly complaining, but never doing anything about it,” Trump has positioned himself outside the Washington establishment. That is the primary reason he won the Oval Office.
Yet President Trump, the “outsider,” is now at the top of the establishment food chain. As a result, he can say what Washington politicians can’t or won’t say, and they have to listen. President Trump, beholden to no one except the American public, can say out loud that Washington is the disease, not the cure. To cure our sick health-care system, we must get the federal government out of health care.
In another part of his inaugural address, the new president said, “What truly matters is not which party controls our government, but whether our government is controlled by the people.” Change the word government in that sentence to health care, and read it again. Health care should be “controlled by the people.”
President Trump should therefore take charge and tell Congress to do four simple things. (1) Repeal Obamacare in full—every bit of it. (2) Repeal Medicaid, EMTALA, HIPAA, UMRA, MACRA, and all the other federal health-care fixes-that-failed-or-backfired. (3) For now, continue federal health care support to the states as block grants without strings.
(4) Then, let the people in each state decide what kind of health care they want. If Vermont wants a single-payer system, let them have it. If Texas wants a free-market-based system, Texas should be able to decide. That is the essence of using the states as “laboratories of democracy,” as recommended by Supreme Court Justice Louis Brandeis.
U.S. health care is critically ill. Americans mistakenly look to the very people who are making it sick to fix it. We expect cancer to cure cancer. The new president has been called the “Great Disruptor.” He can transform health care by disrupting it. Take health care out of Washington, where it doesn’t belong, and put it where it does belong—in the hands of the people.