The Premise of Repeal and Replacing of ACA/Obamacare is to not ruin Healthcare in America, but to Fix It. So here is my list (now that you have Price and Trump’s thoughts), these are things I would add to the overall conversation so the plan is more complete by design prior to implementation. The main focus we need to focus on is cultivating a market system that incentivizes options, coverage, cost reductions, & competition within a basic framework of popular understanding for what is a fair starting point- then let the free market take it from there.
Let's start with this- Who signs up for Obamacare? Given that the “signups and success” of the market place have NEVER been released by this “transparent” Administration, we don’t know. I believe that critical to any replacement is having ALL the information. IF it shows that Medicaid and Medicare was the huge bulk of the sign ups (my belief that this is the case), then we need to shape the new plan to accommodate those people in a different way than we would blindly write another plan. (Can you imagine if all we had to do was roll in the uncovered into Medi-programs and skip this whole Obamacare fiasco?? And have done it for Cheaper than the Trillions it has cost us??)
“Patient First” is a good start by Secretary Price, but how do you get the private sector to play along? If you aren’t mandating by law, then why would ALL businesses do it? I would design in a tax incentive to the “Trump Tax Reform Plan” to inspire businesses to offer Healthcare. Let’s say a 1-2% Corporate Tax reduction if you offer it to staff.
Also, we should incentivize in the New Tax Code that preemptive actions should be rewarded: Mammogram/Prostate/Colonoscopy testing, BMI within a solid range, blood testing, etc(this would reward clean living and skew the costs more fairly to those that burden the system). If you catch things earlier, then they are CHEAPER to handle. Remember, all claims in the “universe” of our population are piled into the math for creating pricing models so earlier, cheaper, more focused treatments are critical in changing the future pricing model.
Global Drug Pricing is an issue. Four things- 1) Create a fairer dynamic in the Generic model (longer time before a drug comes off patent and set pricing of generic below original to create true value for patient) and 2) Revamp the global pricing to make Americans pay less of a global subsidy for other nations (currently we pay much more than any other nation for exact same drug, so they can pay less) 3) Open Borders to buy drugs legally from other nations, if you choose (with admitted risk of having a less secure drug provider) and 4) repeal the Bush Plan that blocks Medicare and Medicaid from bulk negotiating there drug pricing.
Insurance should be unleashed to allow coverage across state borders.
Insurance Companies should be mandated to provide some type of coverage in all 50 states and 7 territories. The more options we have, the better it is. Remember, insurance companies are only investment companies (they store the money we pay, invest it for their own gain, pay a part out in claims, and then tweak future pricing so they can’t lose as they repeat the cycle each year).
Deductibles/Co-pays should be slightly increased for the poor and elderly for minor issues, but reduced for major issues.
Deductibles/Co-pays should vary by Region to accommodate cost and income curves.
Each year an individual or company stays in or with their current plan, they should get a cost reduction. If an individual or family has a claim free year, they should get a reduction in next year premium (if you had a claim they would raise it, so wouldn’t the opposite be true?)
Pre-existing Conditions should never be an issue, either work it into the math or provide a larger Government credit to offset this.
Revise the list of what is covered and what is not. Elective items (wants) should not make Life sustaining (needs) more expensive. It shouldn’t come down to “death panels” but in simple common sense, although awkward would be much more effective than any alternative. Example: Is it Prudent to give a hip replacement to someone in their 80’s? You can make the case both ways, but if the position is “We can’t pay for everything, so we need to make Tough but Compassionate decisions”.
Any Emergency Room visit (that isn’t covered by insurance) should be mandated to include a background check for legal status and blood testing for illegal drug use prior to services rendered. This would prevent unnecessary visits reducing the strain on services and also hold people accountable for their status or lifestyle decisions. The American public should not be made to carry the burden for either one of those issues. Any undocumented person would be deported. Any person found using illegal drugs would be processed within the realm of the law, and any repeated issues would escalate.
Children (living at home) should be incorporated into ones coverage until they get their own coverage.
Healthcare should be a Pre-tax withholding to make it more affordable.
Healthcare Spending Accounts should be highly incentivized to save additional money for the Middle Class.
There should be Bundling of Insurance (Health, Home, Auto, and Life) for Families. This vehicle should be created to provide a flat rate discount for multiple coverage’s (think of how much we pay each year that simply never gets used). If you don’t have a claim in given you, then you receive a rebate. If you do, then you pay normal rates.
Medicare and Medicaid should be completely combined at the Federal level to reduce the redundant bureaucracies they both possess. This would streamline and automate the inefficiencies out of the programs, reduce costs, and give more money back to truly serve the needs of the elderly or poor.
My wish (and I believe Trumps focus as well) is for the Healthcare issue to be redefined to actually address the Costs, Structure, and Coverage for All Americans in a Bi-partisan way (as opposed to the highly toxic process the Democrats rammed through in 2009 when they alone made all decisions, they write behind closed doors, and they voted on without even reading).
But make no mistake, the reason for Obamacare’s failing was its lack of truly addressing these issues By Design. It was never intended to be a stand-alone bill to redefine healthcare and fix it within the private sector with Government oversight, but merely a vehicle to dislocate 1/6 of the United States Gross Domestic Product and pull it into the Government as part of a single payer controlled framework as its end game.
Trump will need to address the Cost, Structure, and Coverage Wisely, as all Americans will at some point have a need to affordable and quality healthcare. Part of his articulation will have to convince America that they can’t have great coverage for free, nor should they have poor coverage at expensive prices- the truth lays in the middle. What we need, plus what we (individually) want, should be affordable and available to us to choose to buy or choose to ignore at our peril/benefit.
Healthcare is debated as a Right or a Privilege. Which is it again?
That you will have a need for it someday, isn’t necessarily the context to make it a Right to every person.
Behaviors & ones individual choices should impact Your rates, not burden society with paying for Your Choices.
“Obamacare” should be Repealed, but ONLY when Replaced Completely- not piecemeal, as that is a recipe for disaster.
Reality dictates we address this monstrosity head on and early in the Trump Administration.
Politics will dictate differently, which is how we got into this mess in the first place.