Thursday, March 3, 2016


Donald Trump put out his ideas for replacing Obamacare and while it does have a few really good ideas in it, it is ultimately going to fail. Here they are in all their glory:

- Repeal Obamacare. “Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.”
- Repeal the McCarran-Ferguson Act, and allow the sale of insurance across state lines. “By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.”
- Allow tax payers to fully deduct health insurance premium payments in their tax returns, as businesses can. “Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions?”
- Review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
- Allow all individuals to use Health Savings Accounts (HSAs), and make those contributions tax-free and allow them to accumulate year after year. Make them part of an individual’s estate, able to be passed on to heirs without fear of any death penalty.
- Require price transparency from all healthcare providers, including clinics and hospitals.
- Block-grant Medicaid to the states. Incentivize the states to seek out and eliminate fraud, waste and abuse to preserve government resources.
- Remove barriers to entry into free markets for drug providers that offer safe, generic options. “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.”

Let's start with the good parts before I eviscerate it.
Selling across state lines is a good idea as long as it doesn't allow crappier and crappier insurance to be sold, devaluing the product. It could allow for lower costs if handled correctly.
Transparency for all health care providers should have been part of Obamacare but as it was partially written by the insurance, Big Pharma and hospital lobbies, that was never going to occur. If people saw how much they were being gorged they would freak out. This is an idea long overdue and I have to give props to Trump for championing it.
Allowing tax payers to fully deduct health care costs is also a new idea and one I wonder if it would work. It is odd that businesses can deduct health costs and rent from their taxes but the rest of us get screwed. I would like to see further review of this to predict it's viability but again I applaud Trump for coming up with better ideas than any from the GOP these last ten years.
Using HSA's is also not a bad idea especially if they are tax free and allowed to accumulate. It could also be used as a unique tax dodge but that could be remedied with legislation preventing that.
Reviewing Medicaid better not be slang for eliminate because we need it. This point could go either way.
Then there are the awful ideas, starting with the least worst to the catastrophic.
Using block grants for Medicare and Medicaid will lead to many not getting the help they need as block grants always run shy of the money they need as governments dramatically underestimate the amounts needed and shrug when states ask for more. This plan guarantees thousands of poor people die every year.
But that matters little because the one fact that Republicans hate and want to get rid of, the individual mandate, is the only thing that keeps insurance viable. Without it, there is no incentive for people who are NOT sick to have health insurance, meaning the risk pool for every company will have NO healthy people in it. This means premiums will skyrocket to ten thousand dollars a month and no procedure costing less than a million dollars out of pocket. That is not an exaggeration. 
Without the individual mandate saying everyone has to have insurance, the system will fail and quick as it will prohibitively expensive for anyone not a billionaire. When people start seeing their grandparents, their spouses, THEIR CHILDREN dying, how long before dead politicians litter the streets? This plan ends health insurance as does every single plan put forward by the GOP so far. As much as I hate Hillary, her insurance plan doesn't require the end of it first.
The individual mandate is needed to keep insurance for all. The other result is nobody gets anything, except for the very, very rich. How well do you think that will play out in the grand scheme of things?

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