Health Care Policies of the Candidates for President of the United States

 

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Current Health Care Policy

Obama Care, the Patient Protection (protection from getting health care) and Affordable (joke) Care Act

  1. Introduction:
  • ACA is legislation passed on March 23, 2010, designed to fundamentally change the way American healthcare is designed and implemented.
  • It aims to overhaul expansion of coverage, workforce reform, cost control, insurance reform, quality reform, and increase focus on wellness and prevention.
  1. Why did we need PPACA?

Healthcare statistics

      1. Costs of Healthcare today:
        • American healthcare is twice as expensive as the average industrialized country.
        • $2.6 Trillion spent on healthcare in the U.S. annually, 17% GDP
        • $8500 per capita in U.S., in 2012 
          • (China spends $7/capita, India $36)
        • We pay double to triple the costs of other industrialized countries
        • Estimated costs to go to 25% GDP by 2025
        • Medical costs are the #1 cause of bankruptcy in the U.S.
        • Insurance premiums are up 400% in 10 years, wages are up 34%.
        • Starbucks pays more for it’s healthcare than it pays for coffee.
        • An MRI of the brain costs $105 in Japan, $4500 in North Platte.
        • Instead of spending our money on screening, prevention and chronic disease management we spend on procedures, tests, and treatments
        • Medicare population will double in the next 15 years.
      2. Quality of the U.S. Healthcare system
        • Of the 11 industrialized nations, the U.S. ranks 11th in life expectancy.
          • some African countries life expectancy is 43 years
        • We rank 19th out of 19 in mortality amenable to medical care.
        • We have fragmented, non integrated, unaccountable healthcare system
        • As the number of primary care doctors goes up in a community then costs come down, quality and satisfaction are improved. It’s a linear relationship.-1   
        • tests and procedures do not equate to better health
  1. Healthcare philosophy and behavior
      • The fundamental questions is: Is healthcare a right of all citizens or a privilege that has to be paid for?
  • “The U.S. healthcare system is absorbed in treating disease rather than preventing it.”-
  • 40% of deaths are related to obesity, diet, nutrition, lack of exercise, smoking and excessive alcohol, not wearing seat belts, etc.-1
  • There are only two factors shown to decrease healthcare costs; access to insurance and a relationship with a personal, primary care physician.-1
  1. In summary: Good and Bad of ACA

The Bad:

  • High deductible insurance plans, higher premiums demanded by private insurance industry to “cover the cost of the sickly new patients signing up for insurance.”
  • Record profits are being realized by private insurance companies.
  • Subsidized premiums for 70% of Americans
  • Expansion of Medicaid to cover indigents

The Good:

  • Innovative cost and quality programs to increase the value (quality/cost) of health care.
  • It has momentum, in it’s 6th year, billions of dollars and untold hours and energy spent already to implement and innovate changes in US healthcare
  • kids on parents policy up to age 26
  • No pre-existing health conditions can disqualify you from coverage.
  • Motivating doctors and hospitals to improve quality, and measure results.
    • if a patient get’s an avoidable complication in a hospital, it may not be covered by Medicare.
    • If a Medicare patient is readmitted to the hospital in less than 30  days, Medicare will not  cover the cost of the readmission.
      • this has led to innovation to prevent readmissions, whereas before it was a financial windfall for a hospital system to have readmissions, more fees!
  1. Definitions of Health Industry Terms

Medical Industrial Complex– the conglomerate of parties involved in health care that fight change and reform tooth and nail: Hospitals, Insurance companies, Pharmaceutical Manufactures, Medical device manufacturers, Physician Groups like the AMA and other specialty groups.

Universal Health Care

Health insurance for all citizens of all ages provided from a government entity paid for by taxes.  Like we all have police protection, fire protections, military protections from foreign aggressors.

Socialized Medicine

Generally means universal health care for all, paid for by public funds, and employing the health care team to provide that care.  This is what Great Brittan implemented.  Canada has universal care but private health systems to provide that care.

Health Care Systems

Large incorporations of health care assets into a single entity.  A system will include hospitals, urgent cares, ER’s, nursing homes, doctor offices and pharmacies and ancillary services like therapies.  Example: CHI, Mayo, Cleveland Clinic, Banner Health, Kaiser Permanente

Healthcare models in other countries

Single Payer-Private providers

Canada, South Korea, Taiwan

U.S.-Medicare, Medicaid, Indian Health, Military Tricare

Single Payer-Government employed Providers

Brittan, Norway, Spain, Italy

Multipayer-Private providers

Germany, Switzerland, Japan, U.S. (2/3 of our healthcare)

Multipayer- Government  or large system Providers(Kaiser, Mayo, Cleveland Clinic)

U.S. is alone

Positions of our candidates for POTUS

Republicans:

Donald Trump:

  • Repeal ACA.
  • Buy insurance across state lines.
    • (Which is silly to think that will cut costs, there are only 3 major insurance carriers.  Fords are not cheaper in KS or CO than in NE and can be sold anywhere to anyone.)
  • Use HSA to pay for bills not covered by insurance.
    • (I’m not sure Donald Trump worries too much about financial issues that the rest of the American’s are concerned with.)
  • No plans to change Medicare.
    • In regards to Medicaid he says he will make a deal with hospitals.

Ted Cruz:

  • Repeal ACA, the CBO estimates it would cost $350B to repeal ACA over 10 years.
    • he spoke for 21 horus on the floor of the US Senate in 2013, reading Green Eggs and Ham, by Dr. Seuss.  At least his book was written by a doctor.  Had he read “Fractured” by Dr. Ted Epperly we might have all learned something.  He was leading a movement to defund the ACA.
  • Expand health savings accounts to cover deductibles and copays
  • Sell health insurance across state lines.
    • (from all 3 companies)
  • Medicare reform:
    • raise the age of eligibility,
    • tiered options: pay more for more complete coverage.
  • Wants to delink insurance from your job, make it portable.
    • (So if the employer is paying for it, how do you do that if the employee is fired, or quits, or wants to retire?  Answer, either the individual starts paying $1500 per month for $5k deductible insurance or the government pays it.)
  • Repeatedly fear mongers on the campaign using the threat of “rationing” if we have universal health care.
    • (We have rationing now, it’s a daily issue.  It’s in the form of denials by insurance for services your doctor orders, formularies, nursing home refusals to accept patients, high costs of care also rations our choices.  Don’t let politicians scare you with the “R” word, rationing is part of life, being done now.  Rationing can mean making informed decisions about treatments and tests that will not benefit our quality of life and may do harm and cause pain and suffering.)

Marco Rubio:

  • Repeal ACA, replace with tax credits to pay for insurance.
  • Purchase insurance across state lines.
  • Speed up the generic medication process,
    • by this he must mean changing patent laws.
  • Privatize Medicare and supplement the policy with a “base rate” and seniors pay extra for the policy they choose.
    • essentially take our most efficient health care delivery system and throw it back to private insurance industry and then supplement it at a base level and make citizens pay for a better plan if they desire.

John Kasich:

  • PCMH model of innovative care delivery, already part of the ACA.
  • this philosophy is more in line the Primary Care physician groups, like the AAFP
  • many of these concepts are already being implemented in the ACA

Democrats:

Hillary Clinton:

  • Supports ACA.
  • Cap spending out of pocket to $250 per month, lower deductibles and copays.  3 visits per year, no deductible applies.  Currently we have one visit for an annual physical that is free.
  • Tax credit or refund if a family spends more than 5% of it’s income on health care, up to $5,000.
  • Push for price transparency at hospitals and offices so people can shop and increase competition.  This is a good thing, just like retail.
  • import drugs from foreign countries with safety standards similar to the FDA.
  • Cut patents on drugs from 13 years to 7.  Thus more generics.
  • Deal with insurance companies through anti-trust to prevent further consolidations.
  • Strengthen state powers to limit insurance premium increases.
  • Save Medicare money by negotiating drug prices.
  • Cut hospital and doctor fees by lumping reimbursements into one payment based on a diagnosis or symptom, instead of fee for service which pays doctors to order more tests and do more procedures.
    • This is good idea as well, and is being done now with ACA.

Bernie Sanders:

  • Universal health care, the only candidate to promote.  The most radical proposal.
    • Medicare for all.  Funded from tax revenues.
  • Private insurance only for supplemental plans.
  • Import drugs from Canada.
  • Require drug companies to disclose the prices they charge in Europe for the same drugs.
  • The federal government will set the fee schedule for doctors and hospitals.
    • Some doctors and hospitals may not accept the rates, thus opting out and creating a black market or 2 tiered system.
      • This is happening in the U.K. now.
  • “We spend 3 times more on health care than U.K., 50% more than Canada for much worse outcomes.. “(paraphrased) – Bernie Sanders

What the various parties involved are thinking

American Public:

  • Current opinion on Obama Care, Affordable Care Act
  • Most Americans approve of the policies and provisions in the ACA,
    • even though they don’t know that is where the policy came from

Doctors:

  • Some doctors like the status quo, it is working nicely for them.
  • Some want to see innovation and quality improvement initiatives.
  • Doctors are frustrated by payment systems that are essentially a gamble for them based on outcomes of health conditions and costs of care that are not in their direct influence.
    • How can a doctor control the lifestyle of a patient.
    • How can a doctor control costs at a hospital he doesn’t own or manage.

Hospitals:

  • They like the status quo.
  • They are nervous about change because they are slow to adapt.
  • They are spending a lot of time and money to negotiate on their own behalf to maintain a profit and market share.
  • They are stressed by employing expensive doctors, and buying expensive technology and accommodating endless rules and regulations of the federal and state government.
  • The ACA has been an incredible stress to them to change and adapt.

Summary and Opinion:

Current reality

We have nearly the worst healthcare system in the world.  We finish near the bottom in almost every category.  We spend the most of any nation, by a factor of 2 or more.  If we continue the innovations of ACA we will improve the quality of care in the U.S., and decrease it’s cost.  We can have the best health care in the world but it won’t come from doing more of the same policies we have done to date.  You can’t go from worst to first without radical change.  Elections are the opportunity to change the direction of our health care delivery system in the U.S.

Career choices and bankruptcy

Our workers are staying in jobs they don’t like or don’t need, just for the health insurance.  Privately insured individuals, like me, can spend up to $1500 or more for coverage that has $12,000 in deductibles before any payments are made on health care bills.  That is $30,000 out of pocket in any given year.  Medical costs are the number one cause of bankruptcy in the U.S., even among insured individuals.

Retirement and employment for younger workers

If we had universal health care that followed us from birth to death and independent of employment then our economy would change dramatically.  Employers would not have to incur the expense, they would hire more workers.  Workers could be more mobile, even start a small business and not worry about their family being uninsured.  Older workers could retire if they have the ability and not worry about spending $1500 per month for insurance.  This would open up jobs for younger workers that need them.  Medicaid could go away, eliminating the number one cost to every state government in our country, and shrink government. Everyone could afford to go the doctor for necessary preventive care to further decrease costs in the long term.  With one universal payer, i.e. Medicare, doctors and hospitals wouldn’t spend millions of dollars negotiating with middle men, hiring lawyers to negotiate contracts, forming defensive organizations, like ACO’s and PHO’s, to combat insurance companies.  We could make national decisions on what we are willing to spend money on, and what we are not.  We can have one formulary to prescribe medications, putting pressure on the drug companies to develop and price products affordably.  If a medication were not on the formulary, people can purchase it privately at fair, market driven competitive prices.

Universal Health Care

Universal health care doesn’t mean all citizens are going to pay the same for their health care or insurance.  Many candidates are already talking about Medicare reform to include paying for choices in coverage.  We can have an insurance rate tiered to our income, just like our income tax.  Cap it at 10% of income, but then refund some money the next year if we are healthy and meet criteria on costs and health parameters.  Keep the deductibles affordable and limit copays or have escalating copays for each visit after 3 per year.  Encourage and legalize innovation in health care delivery, like telehealth.  Cut doctor’s costs through liability reform, cut licensing and credentials hassles to make physicians and nurses more mobile and flexible so we can go practice anywhere in the country and fill in the underserved areas.  Hospitals spend double the salary for locums workers due to the middlemen involved getting licensure and credentialing. Reform physician Residency training programs to design a health care work force that will meet the needs of our aging nation, not pander to the lifestyle choices of 25 year old medical students whom we have invested a million dollars educating and then let them become sub specialists and fleece us with fee for service health care.

Motivation

Universal health care coverage would have another benefit, motivation  for prevention.  Currently we have one insurance up to age 65 and then are turned over to Medicare.  So, the private insurance industry lacks the motivation to emphasize prevention.  Prevention pays off as we get older, and put on Medicare.  So neglecting prevention when we are on private insurance costs our public insurance, Medicare, billions of dollars to treat diseases that we should have prevented for pennies on the dollar.  It will be easier for a government based Universal health care system to financially reward good health behavior and prevention through our tax system.  If you are working to stay healthy, and your costs are lower, you are meeting health parameters that we establish then your taxes are lower, or you earn an income tax credit.  Private insurance could do it as well but they would have to be forced by law to offer refunds if parameters are met and costs are contained.

Eliminate Middlemen

Universal care would eliminate so many middle men in the industry it would be mind boggling.  Billions of dollars could be saved.  If profit were removed from the health care industry by eliminating private insurance companies, all their agents, the lawyers writing the contracts, the expense to the doctors to negotiate with several different companies, the management of hospitals, the PBM industry that plays with formularies, etc.  Between eliminating all this waste, and incentivizing healthy lifestyles through tax policy we may be able to cut our medical spending in half!  That is $1 trillion in savings per year.  It could almost balance the budget for the federal government.

ACA

If we continue to tweak ACA initiatives to improve quality and decrease cost then we save even more.  With the right leadership we could be on our way to the best health care system in the world, instead of the worst.  Donald Trump is right about one thing, our politicians are bought and paid for by special interests.  No bigger interest group exists than the Medical Industrial Complex.  They fight change by bribing our politicians with campaign support, and likely many other under the table benefits.  We the people can take back our government by getting involved and writing our leaders and holding them accountable.  Many of the representatives blindly take a party line position on reform, not even thinking independently about how to solve these tough issues.

The ACA has brought us a long way down the path of reform.  There is a long way to go from being worst to being first.  Throwing out the ACA and all the innovations that have been implemented would be a crying shame and set us back a decade.  The CBO estimates a cost of $300 billion to repeal the ACA.  Our system is still broken and more reform is necessary.  Let our politicians know that health care reform is important to you and your children and grandchildren.  Tell them you want a leader that will keep innovating, keep changing, and keep improving our health care delivery system.  Don’t be swayed by the drama of Obama hating and fear mongering about repeal.  Realize that 70% of Americans like the provisions in the ACA.

Personal responsibility

If you want to help America be healthier, then take some personal responsibility in the matter of your health.  Adopt healthy lifestyle habits: don’t smoke, eat healthy, exercise, and maintain an ideal body weight, wear a seat belt and a helmet if you ride bicycles or motor cycles.  Forty percent of our health care costs are caused by our bad habits.  Write your representative about your views on health care reform.

References:

WebMD

NY Times

Candidates Web Sites

“Fractured”, Dr. Ted Epperly-1

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