Transparency for prices. Require hospitals and clinics to post their prices for all treatments, medications and services. The disparity in pricing can be astonishing. An enterprising entrepreneur, Mark Galvin, who is also CEO of MyMedicalShopper in New Hampshire, found that the fee charged by hospitals and clinics in the region for a nuclear stress test for heart patients ranged from about $1,450 to $7,000. The third-party-payer system and the lack of pricing transparency is why healthcare doesn’t experience the fast, relentless pressure of lowering costs that’s routinely found in other markets. If wide-screen TVs had fallen under the auspices of today’s medical system we’d still be paying $10,000 for them instead of a few hundred bucks.
Medicare transparency. Reveal each year what Medicare recipients, such as hospitals, clinics, and practitioners, receive in payments from the Medicare program. Such information would be hugely useful in ferreting out fraud, as suspicious patterns and practices would be quickly apparent.
Equalize tax treatment. Employers and the self-employed can deduct their premiums. Individuals can’t, which can immediately put them at a huge disadvantage regarding the effective price they get for insurance.
Freedom of choice. Let people choose their own policies, not be required to accept what bureaucrats think they should have. (I shouldn’t have to buy policies with pregnancy services.) Why congressional Republicans last year didn’t pass such a bill and watch Obama squirm as he vetoed it is amazing. It would have made a great campaign issue.
No more buy-this-or-else mandates. Forcing employers and individuals to purchase insurance is un-American and unconstitutional, Chief Justice John Roberts’ farcically contorted reasoning notwithstanding.
These measures would be immensely effective and popular. They would go a long way toward giving the American healthcare market the attributes we take for granted in others: cost-reducing productivity and innovation, accountability and genuine choices, instead of the one-size-fits-all structure we’re being squeezed into today, which will lead to more and more deadly rationing.
Other changes are needed, but we’ll never get the free-market, pro-patient ball rolling if reformers try to do everything at once.
Republicans will have to deal with the issue of safety nets, and they should be readying legislation that will allow the states to create high-risk pools for genuinely uninsurable individuals, as well as provide some of the funding. Otherwise, we’ll continue to be stuck with the take-all-comers mandate for insurers that’s led to an enormous gaming of the system: Don’t buy coverage until you’re sick.
The GOP should also leave alone the popular family-policy mandate that covers children until they reach the age of 26. Pick your battles carefully!
Here is some history about HillaryCare, which was the forerunner of Obamacare. This is by Mr. Gramm, a former chairman of the Senate Banking Committee and visiting scholar at the American Enterprise Institute.
“Where Clinton Will Take ObamaCare” by Phil Gramm, The Wall Street Journal, 10-18-16
“In claiming earlier this year that the current US healthcare system was “HillaryCare” before it was called “ObamaCare,” Hillary Clinton was telling the truth—but not the whole truth. In 1993, while first lady, Mrs. Clinton led a task force to deliver universal healthcare to the voters who elected her husband. She failed. After many revisions, the final bill stalled in the Senate for lack of Democratic votes.
HillaryCare was a comprehensive plan for the government to take over the health-care system, with program details and cost- control measures precisely defined. Having learned from that defeat, the Obama administration left as many details as possible to be written during implementation after ObamaCare became law. With few details to defend and the clear falsehood that “if you like your healthcare plan you can keep it,” President Obama pushed through his “signature” legislation.
While Bill Clinton recently denounced the affordable care act’s effect on the healthcare market as the “craziest thing in the world,” ObamaCare was never anything more than a politically achievable steppingstone. As with HillaryCare, a single-payer, nationalhealth-care system has always been the goal.
Hillary Clinton’s Health Security Act of 1993 would have broken the nation’s health-care system into Regional Healthcare Purchasing Cooperatives, which would’ve collectively set treatment guidelines and implemented cost control measures. In the abstract, Hillary care was just as popular as ObamaCare would be 16 years later, some 20 Republican senators initially supporting an alternative plan would have largely implemented HillaryCare.
That’s when Sen. John McCain, the late Sen. Paul Coverdell and I took our fight against the bill to the regional media markets. When we attacked HillaryCare as inefficient, people yawned. When we showed that the program was unaffordable, people checked their watches. But when we focused on the extraordinary loss of freedom that HillaryCare entailed, where the federal government decided the doctor you could see and the services that could be provided, our rearguard action became a crusade.
The stone that slew the HillaryCare Goliath was freedom. Even the Democrat-appointed head of the Congressional Budget Office was forced to conclude that under HillaryCare, health-insurance premiums were federal revenues and all health-cooperative expenditures would be febrile outlays.
The decisions of HillaryCare’s National Control Board, which would’ve determined every allowable benefit and treatment, would’ve been final—not reviewable by any agency or judge. What finally broke the back of HillaryCare was the provision imposing civil penalties for providing treatments not allowed by the regional cooperative and criminal penalties for accepting a separate payment for providing such care within a cooperative.
Families were forced to pay into the regional cooperatives and medical providers to provide all medical care or operate completely outside of them. Since few families could afford to pay the cooperative for healthcare and then pay for additional care, and few providers could afford to operate totally outside the system, any real health-care choice would’ve been extremely limited, very expensive and available only to the highest income families. When challenged to defend the loss of freedom HillaryCare entailed, congressional support collapsed and no effort to resurrect it was made until ObamaCare.
President Obama left out the politically dangerous details of how the program would be structured and how cost would be controlled. But in the endObamaCare passed because he neutralized the freedom issue that killed HillaryCare by lying about the ability of Americans to keep their health insurance. Seldom in any free society has a purposeful lie led to a greater loss of freedom.
In 2008, candidate Obama attacked HillaryCare repeatedly, claiming in a speech in Ohio that Mrs. Clinton’s approach would “have the government force you to buy health insurance, and she said that she considered going after your wages if you don’t.” But the coercion he condemned became the cornerstone of ObamaCare, with an “individual shared responsibility payment” of up to $2,085 levied by the IRS on anyone without health insurance.
The Achilles’ heel of ObamaCare today is the same weakness that failed HillaryCare—the coercion required to force millions of young, healthy people into the exchanges where they can be exploited. Why the Republican majority in Congress has never forced a vote on healthcare freedom, giving families the right—promised by President Obama and his Democratic allies—to choose not to participate in ObamaCare and to buy the healthcare of their choice independent of the exchanges, remains the greatest mystery of the 114th Congress.
ObamaCare’s plan was always to cook the frog slowly. It didn’t immediately close the individual market or shut down the small-group market as HillaryCare did. President Obama granted substantial flexibility in implementation, such as suspending penalties for individuals and employers, waiving income- verification requirements and easing the premium shock on young enrollees by administratively adjusting the community-rating system. But the result of delaying the coercion ObamaCare requires has been an explo
sion in health-care premiums and massive losses by insurers.
Except for the fact that it is occurring right before the elections, the four largest national health insurers dropping out of ObamaCare is not a problem. This is the plan. Eliminating the façade of private insurance is how ObamaCare “morphs” into HillaryCare and ultimately into a single-payer player like Medicaid or Medicare. This is exactly what Mr. Obama and the Clintons wanted to begin with. Right on cue, they are now campaigning for a Bernie Sanders-type nationalized health-care system.
For the ObamaCare of today to be transformed into the HillaryCare of 1993 and finally into a nationalized healthcare system, a president is needed who has the willpower to impose the coercive details, nail down hard deadlines and unleash agencies to tighten controls and squeeze the life out of private insurers. In 1993 Hillary Clinton unapologetically proposed to do just that. If she is elected president she will have the unilateral power under ObamaCare to do it. The loss of what remains of American’s health-care freedom is an election away.
I will begin and end with this question to you; I know you wouldn’t want government telling you what smart phone you can have or what car you should drive, so why would you want the government to tell you what kind of healthcare you can have? The key issue here is FREEDOM!
Introduction: I write this as a medical doctor. I’m now retired, but I remain deeply concerned with the state of healthcare in America. I graduated from the University of Nebraska College of Medicine in 1967, and after my internship, I completed a residency in radiology, also on the Nebraska Medical campus. I practiced as a diagnostic radiologist for nearly 30 years in Kearney, Nebraska. I retired in 1998. During the George W. Bush years, I served on a committee supporting Republican Senators from 2001-2003;we had 50 Republican senators, and I got to spend time with each one, individually telling them my “healthcare reform” story. Our leader was Bill Frist, Senate Majority Leader from Tennessee, who encouraged me to write on this subject. I continue to think and write on my healthcare ideas.
During the presidential campaign period of 2016, when we had 17 candidates at the start of the season, I remembered how President Obama ran his 2008 campaign, frequently making his pitch for Obamacare. He would say “I keep asking Republicans for their ideas on reforming healthcare, but they don’t have any, so we are left with my plan.” Republicans did have ideas, but as they were not speaking with one voice, and had many different ideas, they got drowned out, and Obama won the debate. Fearing a repeat of this divide and conquer technique, I approached my Congressman, David Jolly (Republican, Florida), asking him to try to get his Republican colleagues to come up with one plan and speak with one voice. From this, I started writing this section on healthcare.
Healthcare History in the U.S. — Prior toWWII, surgeons developed insurance systems like Blue Cross to make their payments, which were larger than a typical general practitioner’s charge. While the GP might charge $10 for treating a head cold, a surgeon’s charge for an appendectomy might be $500, or gallbladder removal might be $750. Then the doctors instituted a Relative Value Scale to set the price for all their other services relative to appendectomy and gall bladder surgery. Then cameWWII with its inflationary economy. Wage and Price controls followed to try and control the inflation. Factories, trying to attract workers, couldn’t offer higher wages because of the controls, but found that they could offer health insurance as they competed for workers while unable to offer higher salaries. This is how so many corporate workers get their healthcare paid for by their employers today. So, one big portion of workers got their health insurance premiums paid with before-tax dollars while so many individuals and small company workers had to pay for their insurance with after-tax dollars. This is patently unfair to have different tax rules for different groups of citizens. Then, there came the Veterans Administration and its new hospitals for the returning vets. There were some federal hospitals before WWII, but the VA system followed the war. Initially, this VA program was intended for those who both served during wartime and were impoverished. Further, if a vet declared he had no money, even if he did, the rule was that the VA couldn’t challenge the declaration of poverty. Today, about anyone who serves/served in the military is awarded government healthcare. Then, with the expansion of government in the 1960s, during the Kennedy and Johnson years, along came Medicare. This passed in 1965. Medicare started out with the same fee schedule based Relative Value Scale that the private or non-Medicare side used, but in a few years, as healthcare price inflation heated up (Medicare was designed with no cost-control mechanism in place, so price inflation should have been no surprise), the government ran short of money, so Congress saw that Medicare payments to doctors and hospitals decreased.This prompted doctors and hospitals to increase their charges for the non-Medicare patients or the private side, to make up the difference. Meantime, when Congress wrote the 1965 Medicare Law, they inserted one paragraph creating Medicaid. This was intended solely to cover healthcare costs for impoverished mothers with children. Today, the Medicaid program has been expanded to both all women and men who have incomes below a certain level. States determine the level, and we have 50 joint federal/state programs with total costs hugely grown from its Spartan beginning. Then came Obamacare. Medicare tipped the balance of power from doctors to hospitals, and hospitals found they could combine charges, and make up new schemes, all designed to confuse and bamboozle everyone so no one could figure out what the real charges were. Hospitals, once founded by various religious orders following the 1918 Flu epidemic, became controlled by CEOs, and out the door went any philanthropic and altruistic interest in serving the ill, and growth and bigness became the new healthcare paradigm. So here we are today, with a tremendously complex and terribly expensive and for the most part inefficient and fractured collection of systems to address the healthcare needs of the nation. Many have been left out with no insurance and no way to get insurance, and too many of the uninsured seek care in expensive hospital emergency rooms, others become bankrupt over unexpected and unplanned for illness, and for the most part, those chiefly of older age when health issues start becoming more prevalent, realize that until they reach Medicare age, they’re vulnerable to a mess of a healthcare industry. The Medicare people are happy with their coverage, but seem blind to the fact that this program faces bankruptcy at some point not too many years off, and that something should change.
We all are aware that as time marches on, our technology continues to advance. Cars and many other products have improved and become more sophisticated over time. Likewise, what doctors and the equipment they use, the drugs they prescribe, the diseases managed, and the range of specialties offered advanced immensely over the past 100 years. President Truman proposed a National Healthcare system following the WWII, and envisioned doctors being employed by the government, healthcare facilities owned by the government and all of this paid for by taxes levied on the American people, and every U.S. citizen being covered. The people rejected this, but a partial government system, Medicare, was passed with advocates believing this to be the first step to a national health service. The debate has continued ever since. But what was a primitive health system relative to today’s standard back in Truman’s time is today hugely different, very much more capable, and in its present form very expensive. The healthcare economics today have been very distorted by government offering to some, services basically as much as the covered recipients wanted, at no cost to them, which resulted in, surprise, an explosion in health cost inflation. So, what was a minor expense to the government in 1965, is today (2014) $618.7 billion covering 53.8 million people, and Medicaid, covering 70 million people cost $305 billion (and states spent $190 billion). These, along with Social Security covering 48.1 million people and costing $706.8 billion, have all together run up an unfunded liability over the next 75 years of $11.7 trillion. So, while the politicians tell us there is nothing to worry about, I tell you that the word “unsustainable” just doesn’t do it; think bankruptcy
and the downfall of the United States of America.
Please note that Federal Budget Numbers vary because of different years, etc., so I have included the 2015 number in the Appendix at the end of the chapter.
So, the government entered a privately functioning industry and caused distortions, so what we have today is a more complicated and poorly understood and dysfunctional thing we call our healthcare system. Is there a way out of this mess? I present below a rational way out that if adopted, has the possibility of being affordable, and the possibility of satisfying nearly everyone.
Painting the present picture — It’s easy to understand that the price for a bottle of IV fluid isn’t commonly known.Bommon things like how much a roll of toilet paper costs aregenerallyknown, but most things appearing on a hospital bill have unknowable costs. Then came subsidizing one service as a loss-leader by another service that was unfamiliar (pay for a low one-day hospital room rate came by charging two or three or four times the amount for an x-ray). Next came “syndicates” of healthcare provider systems and insurance systems with secret pricing deals. With this, the patient, getting a copy of the bill submitted to Medicare, shows a charge of say $1,000 being paid $57 to the hospital. Who knows what the uninsured paid. Who knows what the real cost was.The government created distortions everywhere, sono one knows how much things actually cost.
Doctors had their run, too. I was told that before Medicare, there were no uncared sick in town; doctors just provided what people needed, and the poor were taken care of. My first semester of med school tuition cost $450. I lived at home, and had part-time jobs. I graduated with no debt, and I was an entrepreneur out to hang up my shingle and compete. And I did very well. Today’s graduates might have a quarter-of-a-million debt, and are too afraid to hang up their shingle and compete, so they frequently work as employees for a hospital, or if they wish to acquire a mega mansion, they might start a specialty clinic that rakes in big bucks from insurance systems and medical centers.
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