Trump Should Go Big on Health Care
Turn states loose as innovators, create 50 different pilot plans.
Donald Trump. Image from campaign website.
Avid golfer Donald Trump hit an iron off the tee with his first run at repealing and replacing Obamacare. Predictably, it fell short.
It’s time for him to get out “the big dog,” the driver, and hit the long ball. The GOP’s first rendition of “repeal-and-replace” was accurately dubbed Obamacare-light, and it didn’t fly. It was more about Republican ideology — entitlement reform, smaller government and tax cuts — than health care reform. There was no over-aching vision for the American people to grab onto.
Learn from that, President Trump. Call for a bolder reform of what ails American health care. Come at this Gordian knot in new ways. Outflank the opposition. Keep remnants of Obamacare to attract Democratic votes.
Further, Medicaid is the worst managed and the most out-of-control expense at both the state and federal levels. In Wisconsin, for example, Medicaid has ballooned to $8 billion per year – roughly $5 billion from the feds and $3 billion from the state. (Medicaid will soon pass state spending on K-12 education.)
Trump could make the current $5 billion level an annual baseline that would be enhanced by an inflator at the Medical CPI each year.
Then get the feds out of its management. Turn the states loose to innovate. We would have 50 pilots coming up with cost savings and care improvements. Gov. Walker, for instance, wants to add job search and drug testing as eligibility requirements.
He, or other governors, would also adapt proven private sector reforms to Medicaid management, including:
- Incentives and disincentives in the form of high deductibles and coinsurance, offset by a Health Reserve Account. Consumer-driven plans save 20%-30% at private companies. Poor people will behave in a similar way as other consumers; if it’s their money they’re spending, they will spend more wisely.
- Set up medical homes to offer proactive primary care for the poor. Keep them out of expensive (and dangerous) hospitals whenever possible. Some community clinics are already in place, but not enough of them.
- Let medical providers compete to manage the total health of groups of Medicaid recipients. The most effective get more business the following year, and vice versa. All pilots along these lines have worked exceptionally well.
The president could even bolder:
- He could promise to toughen up antitrust enforcement to keep competition in place among health insurers and big health providers. Prices only go one way when the combine, and it’s not down.
- He could tax the earnings of big non-profit hospital corporations. For the most part, they act nothing like non-profit organizations. They pay enormous salaries, reform slowly and spend heavily on lobbying and advertising. President Trump could use the added tax revenue to pay for high-risk coverage for people with pre-existing conditions and catastrophic medical bills.
- He could convert the troubled Veteran’s Administration into a voucher program to allow vets to tap the more effective private health systems. Close down the VA hospitals; raise value for veterans and save tons of money.
- Prohibit drug advertising, as was accomplished with tobacco. Smoking kills people. High drug prices bankrupt people. They gouge companies with pay for employee health plans. (We have five people at our company using Humira for arthritis, a highly advertised drug, at $43,000 per year per person. That’s unsustainable.)
- Require fixed prices from all providers for “bundles” of procedures. The American consumer and their employers deserve full transparency on staggering medical prices. Such consumer protections already exist for other major consumer products, such as mortgages, cars, houses and 401(k) management fees. Medicare already pays in bundles. There is precedent.
- Regulate prices for monopoly or duopoly drugs, where pharmaceutical has people who are hurting over a barrel. Remember that federal research money from taxpayers was often there on the front end of drug development.
- Allow importation of drugs, always far less expensive than U. S. prices for the same drug. Inspect foreign plants and supply lines to ensure quality equivalent is guaranteed. Take away the quality argument from pharma lobbyists.
The most well heeled lobbies in the world resist each of these obvious reforms. So will state and federal agencies, where the bureaucrats often align with the medical industrial complex.
President Trump said he was going to drain the swamp and help the American people. Here’s his chance. Bloated health prices are costing each American home more than $3000 to $5000 more than they should.
Mr. President, let the “big dog” out of the bag, grip it and rip it.
John Torinus is the chairman of Serigraph Inc. and a former Milwaukee Sentinel business editor who blogs regularly at johntorinus.com.
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What a joke of an article, this treats affordable, quality healthcare as some kind of unknown unicorn that we have to figure out. It’s been done better and cheaper… we don’t lack the how. It’s not a matter of “get the feds out of the way”, it’s get insurance companies out the way.
Same tired old right wing talking points.
The proof is in every other industrialized nation that has better and cheaper healthcare than Americans: government run healthcare is the answer. America is way down on the list of successful outcomes for patients and life expectancy. Why are all these other countries providing better healthcare at LESS COST? Trump, Ryan, and Scott Walker all want to stuff the pockets of their contributors. They could really care less about Americans healthcare. They care about protecting the
money spigot.
The Republican goal for health care is to keep creating maximum confusion in the market place of services so desperate ill people can be looted in their greatest time of need. Republicans have no real desire to make health care better and affordable for all citizens. Republicans offer deathcare.
My brother was recently diagnosed with leukemia and health insurance through the ACA is his main lifeline of support for healthcare and for living longer. The Republican plan for him is to go away and die faster.
As for Trump, he acts the part of an incoherent, deranged, immensely ignorant, possibly demented con-man and has no real clue of governing for the betterment of people.
The author makes some sense and if Trump is really going to get anything done, he needs to build a coalition of Moderate Republicans plus moderate Democrats and ignore the fringes. He should put in a basic foundation that requires all states to insure pre-existing conditions, allow states to expand the Medicaid lists (the precursor to single payer) and allow competition in drug pricing.
WI is losing because the governor refused to allow our local medical providers to create networks and were forced to take the federal one. In SE WI the number one industry in terms of employment is health care. With giants like Aurora, Froedert, Children’s Hospital and even Ascension and others, the innovation here could blossom. But I have yet to see Trump get down in the trenches where sausage is made and until he does, tea party leadership under Ryan will continue to offer a product that is probably unacceptable in the Senate, thus to most Americans. I give the author credit for listing some interesting innovations. We all know the ACA is flawed and needs to be fixed.
Torinus as usual has as his foundation for remedying the sorry state of the greed driven U. S. health care system more of the same. Private insurance companies are the most expensive inefficient way to deliver health care, as this country has proven over the last 40 years. Single payer is available in all the other industrial nations. On average they pay a little over half of our cost as a % of GNP , cover everyone and have better outcomes. The Commonwealth Fund.Org does a recurring scorecard on the performance of various nation’s health plans. Ours is always the most expensive with some of the worst outcomes. As long as hard core Republicans like Torinus see nothing wrong with former United Health care CEO Bill McQuire walking away with a 1.2 billion dollar golden parachute from United, the disaster will continue. Currently we spend 18% of our GNP on healthcare, and this is going up. The private model is a disaster, and like a lot of right wing dogma, its failures are ignored and the Torinus’s of the world suggest simply tinkering around the edges of a failed system.
This suggested approach is what we need now that Republicans are in charge in so many states and in control of all three of the Federal branches of government. These political and philosophical enemies of social programs would surely come up with a better idea. If we would just allow the ‘free market” of ideas to flourish, we could find a better way to furnish health care.
That would mean of course, that the people that deliver health care would have to know how much they charge for their services. So the careful, responsible shopper could calculate the best price for the best service.
In what world do Mr. Torinus and his fellow conservatives live? Possibly this one?
http://www.huffingtonpost.com/entry/a-congressman-accidentally-speaks-the-truth-about-the_us_5907f5f0e4b03b105b44bb9e
Wow! Maybe its time for Urban Milwaukee to drugtest its contributors “.Incentives and disincentives in the form of high deductibles,co-insurance offset by Health Reserve Accounts” will surely work for poor people who face every month with how to find enough money to pay for food and shelter to make better decisions when seeking healthcare. Can you picture what Medical Homes facilities for the poor would be like set up by Wisconsin’ s republicans? Rape victims would be told its their fault and lectures instead of contraceptives would be given. Marie Antoinette meet John Torinus out on the golf course.
“Poor people will behave in a similar way as other consumers; if it’s their money they’re spending, they will spend more wisely.”
Urban Milwaukee, why are you publishing this shit? So rich people only spend their money wisely? They never smoke or drink alcohol or abuse substances or eat fast food?
A couple of comments.
1)This is simply the continuation of a failed economic policy on the part od conservatives. They know, as most informed people know, that supply side economics has been debunked by numerous economists across the political spectrum. Conservatives have no other plan orher than to gouge as much profit out of this as they can, and by keeping low information voters involved with their misinformation campaign, they get them to vote against their own self interests.
2) Someone wrote “As for Trump, he acts the part of an incoherent, deranged, immensely ignorant, possibly demented con-man and has no real clue of governing for the betterment of people.” I don’t think trump is acting.
This article is a prime example and reason for a universal health care system. If all states were allowed to set up their own pilot programs you would have 50 different programs that may meet the needs of their constituents, some that would fail to meet the needs of their constituents and some that would discriminate against certain groups because of their (those legislators who design the program) religious beliefs. In essence this suggestion would be a recipe for disaster. Trump and Paul Ryan have a ‘great plan’ for health care for America which is for those who can afford it.
great Plan, John will work.
No Dumb Dohnal. Johnny’s not looking to “work.” He’s looking to GET PAID like the mediocre “big fish, small pond” type that he is.
I think your ideas are right on. Let the state manage it. There are hundreds of innovative health care providers and stakeholders in Wisconsin that can and will create a more affordable, higher quality delivery system for ALL. I look forward to that!
Ryan does not see healthcare as a right to be enjoyed by all Americans. He sees healthcare as a profit based service provided by the private sector. Ryan, Trump and their associates hold no moral belief that people should have access to medical services nor do they hold that poverty in a nation as wealthy as ours is a crime against humanity. Unfortunately those in power hold no moral concerns for those less fortunate. The true measure of our character is how we treat the poor, the disfavored, the unemployed, under-employed, the under-paid and unfortunate. Their absence of compassion is corrupting the decency of our community, state and nation.
“The Wisconsin Plan”: Alternative to Gridlock
Trumpcare/Ryancare version one failed to pass Congress. But a new iteratation has now passed the House. House Speaker Paul Ryan squeaked it through, having recently said, “Obamacare is a collapsing law. Obamacare is doing too much damage to families.” President Trump has made similarly apocalyptic statements, as have most Republican members of Congress. However, it is unlikely that this draconian bill, a tax cut masquerading has health care “reform” will pass the Senate. So we make be right back where we started.
As on many issues, our country is deeply divided on health care. Republicans and others hated the Affordable Care Act, largely because it was Obamacare, and they hated President Obama. Not knowing much about the law’s content, they inflated its obvious defects into existential threats to the nation. On the other hand, many Obamacare haters now appear to hate the Republican replacements because they aren’t Obamacare. Our informed electorate.
What seems quite clear is that our deep divisions are not going away anytime soon. If anything, they are deepening, and we should be looking for alternative paths to addressing the growing animosity and polarization that divide Americans.
Health Care can provide one of those alternative paths. The suggestions that follow might be considered tongue in cheek. They are not. They accurately reflect stated Republican positions, a sober assessment of our seemingly permanent impasse, and a belief that fundamental policy positions should not be obfuscated, as they have been in the past.
These policy positions anchor modern Republicanism. And they reflect “core Republican values and principles,” which cut across virtually every policy area. These values and principles are: hatred of Obama, hatred of liberals, hatred of abortion and same sex marriage, disdain for “the others,” and hatred of government and taxes, except when they pay for the new road that goes past my house.
Donald Trump recently visited the State of Wisconsin, in part to thank a state that helped put him in the White House. In any number of ways, under Governor Scott Walker and wall-to-wall Republican rule, Wisconsin has been a prototype for Trumpism. In the nation’s capital, Speaker Ryan, a Wisconsin boy, is a consistent voice of the Republican reactionary right. Wisconsin Republican stalwarts like Ron Johnson, Glenn Grothman and James Sensenbrenner are also reliable votes on the far right. And, at least for the time being, the president’s chief of staff is also a Badger.
So, given the state’s status as a newly shining star in the modern Republican firmament, here is an approach to breaking the gridlock on healthcare, along with other big issues on which liberals have stymied Republicans over the years. The concept is also consistent with the Republican belief that the states are “the laboratories of democracy.” Here is the concept.
Why not “carve out” Wisconsin as a “model” for the free-market, limited government relationship between Washington and the states, the “hands off” relationship that Republicans aspire to? Call it a “demonstration” or “pilot project” in federalism. Give the voters of Wisconsin the anti-liberal programs that many of them said they wanted when they voted for Trump, Walker, Ryan and the rest?
Imagine this scenario. President Trump, Speaker Ryan and Governor Walker share the stage to announce the “Wisconsin Plan,” federal legislation that would “carve out” Wisconsin along the following Republican lines:
• As a stand alone, make Wisconsin a “demonstration project” for Ryancare/Trumpcare. Use the recently proposed House legislation as the template, for example, allowing the State to exercise its “waiver” on the requirement to cover pre-existing conditions.
• “Block grant” Medicaid to the State of Wisconsin, and give Governor Walker and his successor the “flexibility” to allocate the (shrinking) funds as they see fit.
• Convert Medicare to a “premium support” program. Give Wisconsin Medicare recipients an annual voucher for the purchase of health insurance in the free market; and, in the process, give them control over their own health care. As in the case of Medicaid, this action will eliminate a hated “entitlement.”
• Repeal the Reagan era regulation barring hospitals from turning away indigent patients who lack health insurance. This action will be particularly important for the financial health of rural hospitals, which will see a growing number of such people who have lost their coverage.
Since all of these policies have been part of the Republican playbook for years, none of them should come as a shock, and they should all be “shovel ready.” The Wisconsin demonstration could start as early as 2018.
These are all bedrock Republican principles. They should be put to the test. And Wisconsin is the logical place for that test. And, although Wisconsin would seem to be the logical site, other states should be allowed to compete to be the “carve out” demonstration. Don’t hold your breath waiting for applicants.