Monday

May 29th, 2017

Insight

Fixing Health Care

Bruce Bialosky

By Bruce Bialosky

Published Feb. 20, 2017

Twenty million. That is the number foisted upon us by the Obama administration and all of its believers as to how many people got health insurance because of his signature health care program and how many will lose it if the evil Republicans tinker with the program; i.e., "repeal and replace." Have you ever seen the figures behind that 20 million number? No you have not because it is a phantom number. Like the 97% of scientists believing in global warming – sorry, climate change. Or that the day of the Super Bowl has the highest number of domestic violence incidences. The Left repeats things often enough, echoed by the compliant media, that they begin to believe their own lies.

The Affordable Care Act (ACA aka Obamacare) brought a sledgehammer to something they should have brought a ball-peen hammer to fix. It should have addressed only the uninsured plus the major challenge for the rest of us: pre-existing conditions. Instead, because they really wanted to make our health care system single payer (i.e. government run), they gave us a slew of new taxes (most of them hidden) and really covered very few new people outside of Medicaid. The real number appears to be about 2.2 million gaining coverage outside of Medicaid in 2013-2015. That should have happened through normal hiring and other processes. Medicaid added 11.8 million covered during that period so the real number is 14 million new people with insurance.

We have previously discussed the fact that many of those 11.8 million may have health insurance, but no health care because of the lack of physicians who accept Medicaid with its low reimbursement rates. People cannot find doctors in most rural areas. The doctors they might get in densely populated urban areas may require hours for transit to/from for services.

One of the elements of proposals floated by Republicans is a cap on how much an employer can pay for an employee's health insurance. I never like caps like this. For example, if we had not changed insurance companies we would have exceeded the caps with a $12,000 deductible. Arbitrary caps are just that -- arbitrary. For example, the IRS still thinks a $25 gift to a customer is appropriate or even achievable. These caps don't work.

Here are some suggestions for the Republicans while they are recreating the system bludgeoned by ACA:

1. Get the government out of the private sector health care. Too many requirements for people to have too many criteria loaded on their health insurance. Just require a clear, concise statement by the insurance companies of what is included and what is not included in a policy. Let the companies develop their options to meet the marketplace.

2. The only insurance people should be required to buy is catastrophic insurance or what was referred to as hospitalization (if you end up in a hospital from a traffic or skiing accident.) A 26-year-old should not be required to buy comprehensive insurance that will never be used. That is why they have not participated in Obamacare. That grand experiment failed. If the 20-somethings do not get insurance through work, they are not going to pay exorbitant rates to subsidize their parents and grandparents.

3. Dispense with the penalties and the enforcement by the IRS -- a despicable aspect of Obamacare. A lot of people got hit with penalties this past year and the Obama administration did not tell the world how many owe the government money because of premium supports that were overstated. Stop with the punishment. Emphasize rewards for acquiring insurance.

4. Let's get real about FDA approval of drugs. Not allowing legalization of medications tested and used in Europe is absurd. Not allowing people with virtual death sentences from disease to try an experimental process or medication is near criminal. Having drug tests taking eons and costing hundreds of millions is government in overdrive.

5. For the 9,548th time, the biggest problem with Obamacare was it increased demand, but did nothing about increasing supply (doctors, nurses, hospitals). There may not be a need for more hospitals as stays are shortening, but it does no good to have insurance if you cannot see a practitioner. We need to push down some services that do not need doctors or dentists to lower-level practitioners to increase the supply, especially in primary care. We need to address this issue and no one is looking at it. We keep building law schools to create lawyers to sue doctors, but few, if any, new medical schools.

6. Pricing for services has to become more of a marketplace. People need to know what the cost of their services are going to be before they are incurred. Being told not to worry because insurance will pay for your medical services is not good enough.

7. Please, please, please stop this nonsense that you have to be at a doctor's office to get medical advice. In an era where we have modern communication including Skype where a doctor can physically see a patient why does everyone need to travel across town, sit in a waiting room with people coughing and sneezing to get a diagnosis on simple matters as if it is still 1966? The government insists on doctors only billing for office visits. I beg my doctor to just tell them I was there, give me the prescription and bill me, but no. That is what happens when government bureaucrats and policy wonks make up health care rules.

8. Reasonable levels of deductibles have to be established. Having significant deductibles is good to put the power of decision making back into the hands of the consumer. But $10,000 deductibles do not cut it for average Americans. This is where Health Savings Accounts need to come back into play after being attacked by Obamacare.

9. We need to consider high-risk pools for people with significant pre-existing conditions. These people are the most challenging part of the medical system and the reason people not in this group have the greatest fear. They fear becoming part of this group and not having proper coverage.

These are just some of the points that need to be addressed in this round of revamping our medical system. Dr. Tom Price, Secretary of Health and Human Services, understands these points because he was actually a practicing orthopedic surgeon. This is unlike the current system that was designed by a bunch of policy wonks. Price has had a plan ready for years to replace ACA despite the lie that has been perpetuated that Republicans have no plan, much like the lie about 20 million losing coverage.

Let us remember Obamacare actually threw millions of Americans out of their plans. I was one of them. That actually happened versus the projected number of people who might lose their plans in hypothetical scenarios.

The idea is that we can replace this government controlled top-down plan with one that focuses on control by citizens and their medical professionals.

P.S. They now say (Robert Reich/MoveOn.org) it will be 32 million losing their insurance. They are unhinged.

Bruce Bialosky is the founder of the Republican Jewish Coalition of California and a former Presidential appointee.

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