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Clinton v. Trump 2016: Healthcare (Part 2 of 4)

By: | Tags: | Comments: 0 | October 13th, 2016

As noted in our last blog, I have been watching Secretary Clinton (HRC) for a long, long time. What I didn’t mention is that I have been watching Donald J. Trump even longer. Before Secretary Clinton showed up on the national scene, we have followed Mr. Trump partly because of his exploits in real estate. In the early 80’s, I worked for my family’s construction business, and we obtained licenses in Real Estate, Mortgage Origination, and I became a Certified Contractor (all in Florida). Florida has always been a real estate and tourism driven economy.

By the time Mr. Trump’s book, The Art of Making the Deal came out in 1987, my family business was deep in commercial, residential, and even infrastructure development and construction. I still have a copy of his first edition in my library.

Since our “PWeR News” blogs are focused on healthcare, I will tell you that I am convinced that Mr. Trump has no idea about healthcare; other than his continued comment about “repealing and replacing Obamacare.” Healthcare is a dynamic shifting industry, and I can relate to both development and healthcare (even on a small scale). In Mr. Trump’s platform, he has resurfaced the idea that has already been addressed before; nothing new although, some of it has great potential. Having been in both industries for most of my adult life, there are no parallels beyond something critical in construction, and nearly never applied in healthcare – the “critical path” method. In building and operating medical centers that “critical path” experience made us different in a good way.

I have reviewed hundreds of pages about the positions of Secretary Clinton and Mr. Trump on healthcare, and yes even reviewed their websites on the issue of healthcare.

I have to say I was quite disappointed that Mr. Trump didn’t mention anything about the importance of technology in healthcare. This has been one focal area that Secretary Clinton has spoken about throughout her career.

With material support from both Republicans and Democrats, the key part and take away on health information technology and in particular, electronic health records, is that the master trend has been effectively set in stone by the U.S. Centers for Medicare and Medicaid (CMS) program through at least 2021.

The key parts of Mr. Trump platform on healthcare are the following.

Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.

The first part of this is a big deal! We are not fans of Obamacare however, we understand that Obamacare has saved lives, and has hit on a few items that needed to be reformed.

A. Eliminate pre-existing condition issues

B. Community rating of premiums

C. Standardized premium by age class

Obamacare, or whatever the next evolution of care will be called, cannot be replaced. This would take too much time, cost too much, and hurt too many people. However, it does not work financially or operationally, and whoever the next President will be, he/she will need do major overhauls.

Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.

This is a great idea, and once that time comes, it should be supported by anyone that understands that having 50 state mandates and 50 state regulators is not a free market and is expensive for new insurance entrants. Just like we have state and federally chartered banks, we should also have state and federally regulated insurance companies. Based on what little we know of constitutional law, interstate commerce is the domain of the federal government.

Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions?

This sounds like a great plan! This idea has been explored before and clearly, it will be available in the future when we can get Democrats and Republicans to the table; next time.

As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.

Like my previous comment above, this is another great idea that has been around for a very long time. This will be adopted in the near future. Secretary Clinton has some major ideas in this space that we will discuss in the next blog.

Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.

This sounds like a good idea, however it could benefit the wrong group of people, the wealthiest Americans. I suspect the details of this will be very complex.

Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.

This is my favorite point. I suspect this is going to happen no matter what, as states are pushing for this. Why can’t we buy our healthcare how we buy other services? We will see this point be adopted one way or another.

Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.

Very progressive idea and I am sure that most governors can find a better way to innovate if this can happen. Innovation is what healthcare desperately needs today.

Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.

I suspect that no matter who wins the drug companies, those who have done extremely well under Obamacare will feel a major, major impact.

In part, Mr. Trump’s summary states:

The reforms outlined above will lower healthcare costs for all Americans. They are simply a place to start. There are other reforms that might be considered if they serve to lower costs, remove uncertainty and provide financial security for all Americans. And we must also take actions in other policy areas to lower healthcare costs and burdens.

We agree, and we have noted in our series of blogs about the expected dramatic increase in U.S. healthcare expenditures over the next 20 years or so – lowering the relative cost of healthcare should be the key focus. Lack of material attention to this master issue will have detrimental effects to our economy, driven by personal consumption.

In our recent blog series, we close with our suggestion on what we thought, and we still can’t think of any better way to say it…

What is the solution? We think we know what will for sure help.

1. Reducing the cost of care by using more technology to collect, analyze, and make actionable.

2. Engaging the consumer with their own wellness in part by using more health IT.

3. Promoting better care coordination between providers of care and their patients.

4. Advancing a more efficient and transparent system that reduces waste and administration.

5. Adopting a payment model to be more aligned with care, and less to do with visits.

Stay tuned for next week’s blog as we will focus in on Secretary Clinton’s major ideas.

– Noel J. Guillama, President

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