ObamaCare’s collapsing: Now it’s up to Trump

Despite what the critics say, as a Pediatric Heart Surgeon, former Professor of Surgery, and a doctor for over 35 years, I know it is possible for President-elect Donald Trump to repeal ObamaCare and replace it with a system that works better for everyone, and keeps the parts many people like. It doesn’t involve creating a completely new system as ObamaCare did — all it requires is fixing the flaws in the previous system by targeting each insurance group separately.

Before ObamaCare, the 85-90 percent of people with insurance generally were happy with their healthcare. They wanted more affordability, not an overhaul of the entire system.

{mosads}Costs could be reduced and quality improved by employing what has worked in virtually every economic sector — deregulation and market competition.

Changes such as malpractice reform, and allowing insurance purchase with “pre-tax income”, across state lines, and as groups, would reduce prices and allow portability.

Letting people buy only the insurance they want instead of mandating a “one size fits all” would further reduce prices, making insurance more attractive to everyone, especially young and healthy individuals.

Only about two to four million people are denied insurance because of pre-existing conditions, and about half of these people had insurance, but lost it when they moved or changed jobs.  After a one time exemption to allow everyone a chance to regain insurance, this group could easily be covered by allowing them to keep their coverage when they move or switch jobs and developing well-designed high-risk pools for everyone else.

Equally important, the promise of guaranteed insurability would incentivize young people to buy at least a “starter” policy in order to avoid being delegated to a high risk pool should they get sick — this again will bring more healthy people onto the insurance roles.    

That leaves the 10 to 15 percent that can’t afford coverage.  They need insurance, but with a $20 trillion debt, there isn’t enough money to give them private insurance. In spite of what proponents of government-run healthcare believe, total equality in healthcare has never been achieved, and is no more feasible than everyone having the same car. So what’s the solution?

We know from ObamaCare that expanding Medicaid doesn’t work.  Up to 50 percent of physicians currently refuse new patients because of low reimbursement rates. Without access to a doctor Medicaid patients are flooding emergency rooms, creating backlogs.  Furthermore, the Oregon Health study found giving the uninsured Medicaid didn’t improve any measurement of physical health compared to staying uninsured, and a University of Virginia study found Medicaid patients undergoing surgery had worse outcomes than those without insurance — translation, Medicaid’s worthless.  Or said another way, Insurance isn’t Healthcare. Interestingly, over 2/3’s of those of newly insured people that Democrats cite to defend ObamaCare received Medicaid, making their claim this is a reason to keep it delusional.    

However, there are effective alternatives. One creative option would be to introduce an entirely “new” system similar to Canada’s “single-payer.” Like Canada, each year there would be a certain “pot” of money, for example, the current Medicaid budget. The new program would then pay a doctor or hospital the same as private insurance, making it possible for patients to find a doctor and obtain care; a vast improvement over Medicaid.   

However like Canada, there would be long waits for non-emergency procedures or certain tests, since the amount of money for each year would be capped. If you need help getting Democrats to support this plan you could offer to allow those that can afford insurance and believe in a government-run “single-payer” program the option to “sign-up (public-option)”— I doubt many will.      

When I worked in Canada the wait for some surgeries or medical tests was months, occasionally with devastating consequences. Additionally, a national board decided acceptable medical care, rationing treatments and medications.  In contrast, those with financial means traveled to the U.S. to get their treatment or procedure done promptly — a trend that increased by 26 percent in 2014 alone. Europe is similar. Though the average Swedish family pays almost $20,000 per year in taxes toward healthcare, nearly 12 percent bought private insurance in 2013, a number that has increased by 67 percent in five years despite that Swedes are “guaranteed” public healthcare.  

Washington could also provide vouchers to help low-income individuals obtain private insurance if they worked.  Using healthcare as a motivator might produce results similar to the 1996 Welfare Reform Act, which decreased welfare rates, increased employment, and raised millions of children out of poverty.

There are other alternatives to reform care for the uninsured poor, such as giving states Block Grants with Federal exemptions so they can test different ideas. Rhode Island has such an exemption, and they have cut Medicaid costs and improved care while adding patients. Mike Pence had a similar experience in Indiana and so does Florida.

The key is to focus on the specific needs of each group. By doing so, we can improve healthcare for the “uninsured”, cover those with pre-existing conditions, and allow the majority of Americans to “keep their doctor” while reducing their premiums — everyone wins. More importantly, this approach avoids creating a huge new government bureaucracy and/or healthcare panels to ration care, keeps the government out of the doctor-patient relationship, and accomplishes all this without increasing our federal debt or raising taxes. Affordable care, accessible to all: what a concept.

Dr. Bradley Allen is a pediatric heart surgeon, medical researcher, and former professor and surgical director of the Children’s Heart Institute in Houston, TX.


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