November 27, 2016
President-elect Trump has promised to repeal Obamacare but thus far has been vague about alternatives. Rather than tinker with the system, Mr. Trump should boldly propose that all Americans have a Universal Health Safety Net that protects individuals and families from huge health care bills while lowering premiums for the middle class and working poor. The most straight-forward solution is to provide every American with government-backed catastrophic health insurance.
Because of technological advances, bureaucratic mandates and an out-of-control legal system, the average annual health care costs according to the actuarial firm Milliman, Inc. is $24,671 a year for a family of four. Those who are not self-employed pay $10,473 out-of-pocket while the employee pays the balance. Middle class wages have been stagnant for over two decades and now average $53,657 a year. When the employee contribution is included, many workers are paying almost 30% of their wages for health care.
Providing a Universal Safety Net does not require a new government program. It already exists. It is called Medicare – a plan that protects our elderly and disabled from large health care bills. All that is necessary is to extend Medicare to all Americans for medical bills that exceed $75,000 a year. Purchasing insurance to cover this first $75,000 would be inexpensive. This would be financed by increasing the Medicare tax (presently 2.9%). The vast majority of citizens would see their health care bills plummet to around $4,000 a year.
Further cost containment could be realized by classifying diseases and treatments according to efficacy and level of seriousness. It is well known that removing lung tumors before they have spread or treating hypertension and glaucoma saves and improves patients’ lives. Other treatments – back surgery without a herniated disc, prostate cancer and colon cancer chemotherapy in those over eighty years old – are controversial. These treatments could be partially covered and patients could decide if they wanted to pay out-of-pocket for them or else purchase extra coverage.
Furthermore, bureaucratic mandates are requiring doctors to waste endless time inputting useless data for the government to peruse while the complaints of patients are being ignored. Doctors are literally dealing with an Kafkaesque maze of acronyms – HIIPA, MIPS, QPP, APM, CEHRT, MACRA, PQRS (don’t ask) – that do nothing more than waste time.
Tort reform is crucial too. Forcing doctors to perform unnecessary tests adds 15 percent to medical costs. Doctors are also afraid to use modern technology such as e-mail, Twitter, Skype and Facebook to service their patients. Indemnifying doctors for these modalities would enable elderly patient and disabled patients to be consulted without leaving their homes and decrease the need for family members to take time off work, saving billions of dollars in worker productivity.
This plan would also have several political benefits. First of all, it would attract bipartisan support. Many Democrats would see this as a reasonable compromise to the socialistic plan proposed by Bernie Sanders during his presidential campaign. Secondly, it would allow President Trump to negotiate better trade deals as the health care costs for corporations would decrease. Finally, it would decrease resentment towards illegal immigrants who receive free health care while those who are citizens of the country and forced not only to pay outrageous premiums, but taxes to support the emergency rooms that give the illegals free care. Lowering health care costs would make many more receptive to a reasonable plan to allow more immigrants.
The rise and fall of the Trump presidency will be determined by the upward mobility he can create for the working class who has been left behind by globalization – the so-called deplorables that Hillary Clinton and the liberal media enjoyed ridiculing. If President Trump and the Republicans extend coverage to all Americans for catastrophic coverage, not only will they be doing the country a great service; but they will enable small businesses and corporations to thrive.