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Trump’s seven-point healthcare program

 

The Trump for president campaign offers a seven-part healthcare-reform program:

  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 fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
  4. “Allow individuals to use Health Savings Accounts (HSAs).  {Editor’s note: These are already allowed — and used by millions.} 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.
  5. “Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. (Editor’s note: Such transparency is already called for under the Affordable Care Act.} Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
  6. “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.
  7. “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. (Editor’s note: Many  U.S. patients now get their  prescription drugs from Canada, which are generally much cheaper than American drugs.}

 

 

 

 

 


Citizens’ staggering ignorance about healthcare issue

 

This entry reminds us of the demands at some Tea Party events to “get the government off my Medicare!”” The complainants had to be reminded that Medicare is the government.

It seems that the ignorance quotient is rising with the expansion of the Internet.

Thus a Kaiser Health Tracking Poll suggests that many in the public, increasingly ill-informed about public policy, may not really know what they are talking about when it comes to key healthcare issues.

As summarized by Becker’s Hospital Review, the poll showed:

“The greatest proportion of Americans (36 percent) supports building on the Affordable Care Act, rather than implementing a single-payer plan (24 percent) repealing and not replacing it (16 percent) or repealing it and replacing it with a Republican alternative (13 percent), according the poll. However, the poll also indicated the words used to describe these plans can significantly change how they are viewed — harkening back to the Jimmy Kimmel bit on Obamacare versus the ACA.

“In particular the views of Democratic candidate Sen. Bernie Sanders’s (I-Vt.) plan were misunderstood. The survey found 64 percent of Americans positively react to ‘Medicare for All,’ Sen. Sanders’s universal healthcare plan, and 57 percent positively react to ‘guaranteed universal healthcare coverage.’ However, when asked about ‘single-payer health insurance system,’ 44 percent reacted positively, according to the report. Even among Democrats, there was confusion. About half (53 percent) supported Medicare for All, while only 21 percent positively reacted to ‘single-payer,’  though the terms refer to the same thing.

“When it is clearly broken down for participants as ‘guaranteed health insurance coverage in which all Americans would get their insurance through a single government health plan,’ roughly half are in favor and 43 percent are against it, according to the report.”


Small-group insurance market expansion in play

The National Journal reports that Republicans might get a chance this fall  to overturn the Affordable Care Act’s expansion of the small-group insurance market — and  that President Obama might go along with the change.

A deadline looms:  The ACA mandate that states  widen the definition of their small-group markets from employers with 50 or fewer employees to 100 or fewer is supposed to start to take effect in some states on Jan. 1. But legislation, The National Journal says, “would end that requirement,  leaving the definition at the historical norm of 50 while letting states set it higher….”

Timothy Jost, a healthcare expert at Washington and Lee University, noted  to the magazine some potential problems if the change  were made. The magazine paraphrased him as saying that “While prices might go down for the 50-and-under businesses as their market grew, the 51-to-100 businesses would almost certainly see their prices go up. They would be moving from the more stable and typically less expensive large-group plans to the small-group setting. The small-group market is also subject to some Obamacare rules, such as covering certain essential health benefits, that the large-group market is not. Some estimates have projected that costs would actually increase for everybody.”

Still, “{o]f all the {ACA} ‘fix’ bills floating around the Capitol, the small-group provision might have the most working in its favor: It has bipartisan support, costs little to nothing to change, and even some Obamacare supporters say the law could function fine with the alteration,” the magazine reported.


The 3 big reasons for insurers’ merger mania

 

Wendell Potter, a former executive of Cigna, the huge health insurer, writes that there are three main reasons f0r the wave of health-insurance mergers and none of them are the Affordable Care Act.

Writing on the Center for Public Integrity’s Web site, he says the three reasons are:

Size has long mattered: There’s 20 years of plenty of history of provider and insurance mergers that help explain the new ones.

Changing demographics: The swelling cohort of the Baby Boomers.

A shrinking employer-based health insurance market: “Although the vast majority of Americans with private health insurance get their coverage through the workplace, employers no longer present insurers with growth opportunities.”

But, Mr. Potter says,  “Obamacare appears to have halted this erosion {of employer-sponsored plans}. Membership in employer-sponsored plans has remained stable over the past couple of years, according to the Urban Institute researchers.”

He concludes:

“So the next time you hear a politician or pundit claim that Obamacare is to blame for the dwindling number of big for-profit insurers, know that they either don’t know what they’re talking about or they’re trying to mislead you. More than likely it’s some of both.”


Hospitals somewhat sanguine on subsidies case

 

Reuters reports that hospital executives are ”optimistic they will avoid the toughest consequences of a U.S. Supreme Court decision on whether millions of Americans can continue to purchase subsidized health benefits under Obamacare.”

“Investors interpreted commentary by Justice Anthony Kennedy, a potential swing vote among the nine judges, as favorable to the Obama administration’s defense of the subsidies that help consumers in more than 30 states.”

“I am hopeful that the court will recognize and uphold the intent of Congress, which was to expand coverage as broadly as possible,” Bill Carpenter, chief executive of LifePoint Hospitals, said in an interview.

If the court rules against  federal subsidies, Carpenter and other executives interviewed by Reuters said they expected the justices ”would allow for a transition period before patients lose access to healthcare.”

”Alan Miller, CEO of hospital chain Universal Health Services, expects the Obama administration would reach an agreement with Republican opponents of the law to keep subsidies in place through the end of 2015. He believes that is enough time to create a workaround to the Supreme Court ruling.”

 

 

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Llewellyn King: The new world of work

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One thing we think we know about the Republicans is that they take a dim view of waste, fraud and abuse. So how come the U.S. House of Representatives, in Republican hands, has voted 56 times to repeal or cripple the Affordable Care Act, better known as Obamacare?

They’ve put forth this extraordinary effort despite an explicit veto threat from President Obama. Their repeated effort reminds one of Onan in the Bible, which politely says he spilled his seed on the ground.

It’s a waste of the legislative calendar and the talents of the House members. It’s a fraud because it gives the impression that the House is doing the people’s business when it is holding a protracted political rally. It’s an abuse of those who need healthcare because it introduces uncertainty into the system for providers, from the insurers to the home-care visitors.

It’s symptomatic of the political hooliganism which has taken over our politics, where there is little to choose between the protagonists.

Republican groups think that Obama is the doer of all evil in the nation — especially to the economy — and the world. Daily their Democratic counterparts gush vitriol against all the potential Republican presidential candidates, only pausing for an aside about the wickedness of Fox News.

Their common accusation is middle-class job woes. They’re on to something about jobs, but not the way the debate on jobs is being framed.

The political view of jobs is more jobs of the kind that we once thought of as normal and inevitable. But the nature of work is changing rapidly, and it cries out for analysis.

The model of the corporation that employs a worker at reasonable wages that rise every year, toward a defined-benefit pension, is over. Today’s businesses are moving toward a model of employment at will; the job equivalent of the just-in-time supply chain.

While more of us are becoming, in fact, self-employed, the structure of law and practice hasn’t been modified to accommodate the worker who may never know reliable, full-time employment.

The middle-class job market is being commoditized, as the pay-per-hour labor market includes everything from construction to network administration. Sports Illustrated — synonymous with great photography — has just fired all six of its staff photographers. Don’t worry, the great plays will still be recorded and the Swimsuit Issue will still titillate, but the pictures will be taken by freelancers and amateurs.

Two forces are changing the nature of work. First, the reality that has devastated manufacturing: U.S. workers are in competition with the global labor pool, and business will always take low-cost option. If unemployment goes up in China, that will be felt in the U.S. workplace. Second is the march of technology; its disruptive impact is the new normal. Accelerated change is here to stay.

All is not gloom. The trick is to let the old go — particularly difficult for Democrats — and to let the new in. There will be new entrepreneurs; more small, nimble businesses; and whole new directions of endeavor, from gastro-tourism to cottage-industry manufacturing, utilizing 3D printing. Individuals will be free in a new way.

Government needs to think about this and devise a new infrastructure that recognizes that the nature of work is changing. The emerging new economy should have simplified taxes and Social Security payments for the self-employed; portable, affordable healthcare; and universal catastrophe insurance, so that those who are not under an employer umbrella can benefit from the equivalent of workers’ compensation. The self-employed, rightly, fear the day they can’t work.

Rugged individualism has a new face. The political class needs to look and see the new workplace.

Llewellyn King (lking@kingpublishing.com), an occasional contributor, is executive producer and host of “White House Chronicle” on PBS.


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