Healthcare

Donald Trump’s Healthcare Problem | THCB

imageAs with virtually all politicians, Donald Trump does not understand health care or paying for it. He seeks simple, naive solutions that assume buying health care is like buying any other service and that average people are health care shoppers. Hey just give everyone a voucher to buy the insurance they want  Sure that will do it  🤔

DT: I’m gonna make the whole thing work like a business. The same way my hotels are a business. We’re gonna save big bucks by having proper competition, just like in the hotel business. I’ll tell ya, if hotel rates had gone up like healthcare costs, I’d be a trillionaire not just a billionaire. What we’re gonna do, we’re gonna let every American choose what insurance to buy, just like they can decide where to stay to get the best deal. And we’re gonna do it with a lot less government interference.

MK: How’s that going to work?

DT: See, we’ll give everyone a voucher that they use to buy the insurance they want. Just like they can choose a superior Trump brand resort or a crummy Motel 6.

MK: Why would anyone choose the Motel 6 option for their health insurance?

DT: The voucher will cover the Motel 6 costs, but people are gonna have to use some of their own cash if they want a superior brand. Like mine.

MK: So, back to healthcare, there’ll be more competition between insurers. But isn’t there competition today?

DT: Nah, not really. Most insurance is bought by employers who only want to keep their [bleep] unions happy. If regular people had to use their own cash to get anything more than Motel 6 insurance they’d buy only what they need, for a lot less money. But everyone would have insurance, like I’ve always said.

MK: Where would the funding for the vouchers come from? This is beginning to sound like Senator Sanders’ Medicare for All proposal.

DT: That Bernie! Well-meaning guy, but he’d bankrupt us all with new taxes. I’ll tell ya where the money for my plan would come from. We’ll end this deal where some people get insurance for free from their employers and others don’t get anything. Companies shouldn’t be in the insurance business anyway. Aetna doesn’t build airplanes, so why should Boeing provide insurance? That’s nuts. We’ll get rid of monopolies. We’ll get rid of Medicaid, won’t need it anymore. We’ll get rid of a zillion bureaucrats. And we’ll use vouchers to make Medicare competitive, too. And we’ll do it with no new taxes.

Source: Donald Trump’s Healthcare Problem | THCB

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3 replies »

  1. To add to BenefitJack comments, I am also unable to predict what my medical cost will be several months in advance. I only know what I can presently afford and based on what I spent in the past. The ideal that I can shop for my health insurance and predict my medical illness, accidents, or when I am going to schedule my heart attack and their associated costs is absurd.

    The big difference between health insurance and other types of insurance is the predictable cost. For example if you total your car, you know what a new car cost. If your house burns down, you know what it cost to rebuild. The actuaries know on average also most to the day that you will die. But if you get sick, you have no idea what test your doctor will order, how long a hospital may keep you, or what your out of pocket cost will be. Watching the TV ads for the Medicare enrollment, I had no idea that some plans cover some things or certain drugs but not others. What if you guess wrong?

    Medical insurance plans are just as confusing as the IRS tax code for retirement plans. How is a normal person going to figure it out?

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    • Actually, health care costs are predictable. If you have an accident or an illness where you end up in the emergency room, you will certainly satisfy your deductible, then trigger (typically) 20% coinsurance up to the out of pocket expense maximum in the plan that you enrolled in. What’s not predictable is accidents and illnesses. So, you have to set aside money for the time when, and we all do, end up incurring medical expenses. That is why I have been enrolled in a HSA-qualifying HDHP for what is now my 11th consecutive year, and, over the past 10 years, I have accumulated assets in my Health Savings Account that far, far exceed my annual out of pocket maximum. As a 63 year old, I have less than two years to accumulate monies in the HSA (unless they change the statutes and regulations), because I am unemployed, covered as a retiree, and my retiree coverage after age 65 is a supplement to Medicare Part A, B and D.

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  2. Do you understand all of the systems in your car, in your home, so that you can repair any problem; maximize the functionality? Neither do I. So, we buy insurance, we retain advisors, we keep an eye on other individual’s experience with health care providers, car repair, home repair, etc. Health insurance and health services ARE NOT different, in that respect.

    What the voucher folks say is that you should be able to make an informed decision to purchase the health insurance you need, and because health services are essential, that taxpayers should provide financial support to those who cannot pay (directly, or as a component of their total rewards/wages). That is significantly different than saying you should understand when you need, say, a colonoscopy, how the procedure is done, what the risks are, what information the test will provide, how to interpret the test results, what it will cost, and how those costs and results might differ / across the available endo physicians and facilities that are available (in your current location or anywhere else in the world) – in or out of network, etc. For example, you can’t even get the government agencies to agree that a colonoscopy is preventive – the IRS, in Notice 2004-50, says a colonoscopy where polyps are removed is preventive for HDHP-HSA purposes; while CMS/HHS says that a colonoscopy where a polyp is removed changes the procedure from one qualifying for “no-cost-sharing” benefits treatment to a diagnostic procedure subject to the deductible and coinsurance.

    I dehydrated myself the other day, ended up in the emergency room at my local hospital. The EMS guys could see my condition clearly, I of course, could not and fainted, twice. The squad gets me to the ER and they look at me and see that I am lucid, to the point where I could give them my SSN, frontwards and backwards, but, we’ll monitor and take some blood and run some tests over a period of six hours. Overkill? Probably. Necessary in today’s litigious society? Probably. Best practices medical, well, maybe not as I didn’t see a physician for the first two hours and never saw any physician again for the last four hours.

    So, there goes my $3,600 deductible for 2016. Did I make the wrong decision in signing up for a HSA-qualifying HDHP? Could I have predicted that for the first time in my life I would be stupid enough to dehydrate my body while exercising to the point that I would faint and, from a sitting position, fall to the floor – and could I have predicted that back last November when I made my enrollment decision?

    So, this is the third straight year in a row that I and/or my wife, have incurred expenses sufficient to satisfy a $3,000+ annual deductible. That follows seven years when I was enrolled in a HSA-qualifying HDHP and did not satisfy the deductible.

    Was I sufficiently knowledgeable the first seven years? Was I stupid in the last three years?

    I don’t agree with much of anything the Donald says, but, I am pretty sure I do not want the Donald, Bernie or others to choose my health coverage – what will be covered, what will be excluded. It is bad enough I have to limit myself to what the insurance companies come up with, as guided by state and now federal regulators. More importantly, while we spend to excess here in the US, without our market for health services, you wouldn’t see all the innovation in treatment, medicines, and hopefully, at some future date, a full suite of functionality regarding personalized medical care (the only opportunity I see for actually reducing medical spend – customizing treatment to the individual so that it is ALWAYS cost effective, avoiding all ineffective and inappropriate treatment, and the existing process of elimination used in medical diagnosis, and then repeated in medical treatment). So yes, we spend, we spend, we spend. But, at least we get a return on our “investment”, and slowly, perhaps haphazardly, diagnosis and treatment are improving.

    As we have seen with NICE in England, and luckily, we have avoided (so far) with IPAB, I would rather we ration health treatment based on ability to pay, than having some bureaucrat in the beltway decide what can be provided, and importantly, who qualifies for scarce resources avoiding government mandates that would curtail provision of those services outside the government-controlled system. Those who would decide for you will have to ration unless they can somehow reverse the economic reality of scarcity. See: http://www.healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-economics/4c-equality-equity-policy/priorities-rationing Excerpt: “… While economic evaluations provide a relatively quick and useful decision-making tool, prioritising health services based on economic evaluations alone serves a Utilitarian goal. This may or may not be the desired principle of social justice … and may lead to public outcry (e.g. as caused by The Oregon Plan). …”

    I am not interested in Bernie or the Donald or anyone else’s concept of “Social Justice” when it comes to my health insurance, and/or health treatment.

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