Trump releases Health Care Plan

[drauz]

https://www.donaldjtrump.com/positions/healthcare-reform


Congress must act. Our elected representatives in the House and Senate must:

1. 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.


2. 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.

3. 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? 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.

4. 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.

5. 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.

6. 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.

7. 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.

[GS4Pirate]

Without digging to deep into that, sounds like a good deal for both sides of the isle. I especially like the changes to the HSA, I have always avoided using this because I worry I'm going to lose my money.

[Soulance]

Without digging to deep into that, sounds like a good deal for both sides of the isle. I especially like the changes to the HSA, I have always avoided using this because I worry I'm going to lose my money.
It does sound pretty good at first glance actually. I have an FSA account that I wouldn't get until recently because I always thought it was stupid to HAVE to spend all the $$or lose it. Now they give me a little extra time to spend it. Still dumb, but better. I knew I was going to do Lasik so I used it for that.

[everan]

They need to stop the dual pricing of hospitals and testing facilities. I get bloodwork done and the bill is say $500, but the insurance company (and presumably Medicare) pays only $75 for that procedure, so that's the price. Someone walking in off the street should not have to pay $500. The price should be the price, or close to it. I accept having the insurance company being able to negotiate slightly better rates because of their client base, but 75% better than non-insured? No wonder why it's such a big deal not to have insurance. I would be much better off if I could just buy a catastrophic policy and paid my doctor bills out of pocket. Actually, my new plan is pretty close to that now anyway, everything seems to go to my deductible. I used to have such a good policy!

[elcidcannon]

#7 will be tough tough tough to get done.

[elcidcannon]

They need to stop the dual pricing of hospitals and testing facilities. I get bloodwork done and the bill is say $500, but the insurance company (and presumably Medicare) pays only $75 for that procedure, so that's the price. Someone walking in off the street should not have to pay $500. The price should be the price, or close to it. I accept having the insurance company being able to negotiate slightly better rates because of their client base, but 75% better than non-insured? No wonder why it's such a big deal not to have insurance. I would be much better off if I could just by a catastrophic policy and paid my doctor bills out of pocket. Actually, my new plan is pretty close to that now anyway, everything seems to go to my deductible. I used to have such a good policy!

Nail meets head. Insurance companies control everything. EVERYTHING.

[Whirlin]

Without digging to deep into that, sounds like a good deal for both sides of the isle. I especially like the changes to the HSA, I have always avoided using this because I worry I'm going to lose my money.
You may be thinking FSA, which was pre-Obamacare, and expired at end of the calendar year ever year... FSAs could be spent on a wide array of 'health' related stuff, even gym memberships and exercise equipment were within the guidelines. FSAs were also pre-tax contributions.

HSA was introduced with the high deductible plans, and doesn't expire at the end of year, and allows for investment of current HSA funds, very similar to a 401k... but you can utilize HSA funds towards doctor visits, hospital bills, prescriptions, etc. It was a great system that was introduced... but it's too vast a change to be big bang implemented... it should have been a phased in approach with the newest generation of workers... moving from having a full PPO to a high deductible HSA would have been a decent option if you had the opportunity to build your HSA funds like you build your 401k.

Edited to add: Thinking about it... #1 introduced #4... so... you they'd be mutually exclusive. Can't say you're revoking ALL aspects of it one line, then point out keeping an element of it a few lines later.

Also, the problem with this proposal is that individuals without insurance still obtain medical care... just go into a hospital, give a fake name/address, hospital picks up the bill. Hospitals aggregate total unpaid visits, and compete for state allocated funds, so the taxpayers pick up the final bills. Individual mandate adds personal accountability for medical care, and actually does more harm than good to lower income individuals that can't afford health care. Lack of an individual mandate would actually be closer to a more universal healthcare system, since the eventual health care costs just get picked up by the state at the end of the day without it.

[ClydeR]

Trump's plan is much better at handling preexisting conditions than Obamacare.

[Delcry]

Trump's plan is much better at handling preexisting conditions than Obamacare.

No way!

Obamacare has been the single greatest American achievement in the past 30 years. Affordable healthcare is a right and this fixed the problem.

[~Rocktar~]

The reason there is the so called "dual pricing" is because insurance companies offer providers a contract that says we will send our people to you in exchange for a substantial discount on your services. The provider gets more business and knows the insurance company will pay so they make more money at a lower individual cost. If they reply on people off the street, they don't know if or when they will have business, they don't know if or when they will get paid and they have to absorb the losses for those that don't pay. This is the same thing other companies do with supply train contracts. Health care providers aren't required to sign on and many many do not. In fact, most all anesthesiologists are not in contract with ANY insurance company.

If you really want to improve competition in health care then you can take some real steps to improve availability. Lets come up with a way to inspire more people to become doctors since we don't have enough and a lot of bright young people today have the attention span of a gnat and don't want to spend the time to become a doctor. Lets find a way to spread/inspire more medical care in rural areas, just like lawyers, all the people want to be some specialist in the big cities so they can make the big money. Urbanization is a bad thing in many ways. Next, let's come up with a publicly available way to measure and report doctor effectiveness (I am looking at you mental health and substance abuse treatment providers). We also need ways to limit lawsuits for bullshit. If you have an illness that has a 95% fatality rate and you die, your family should not be allowed to sue because you didn't survive. Seriously, there are a lot of shit lawsuits out there that should never get to court, they cost money and drive up medical costs. Next, people honestly need to get a realistic clue about their health care. There are tons and tons of diseases out there that people will go to insane lengths to try and treat with almost minuscule chances of recovery where if you look at how doctors that get the same illnesses don't go through all that crap.

A new player in the cost of healthcare now days are things like autism and other chronic issues that involve possible life long care that people expect insurance companies to pay for despite it not being restorative in nature and in many (most) cases absolutely no evidence of it's effectiveness. Those costs are going to be born by the group and the cost of care will go up.

Last point, for those that have no damn clue what you are are talking about, insurance hasn't been controlled by insurance companies in nearly 40 years. Employer driven health care is a thing and has been predominant since the late 70s. Insurance companies are paid to administer the plans (do the paperwork and handle the customer service contact) and take the blame.

[Soulance]

With doctor effectiveness and ratings, you're going to get people who complain that things aren't "fair" and that they can't afford getting the "good" doctors. Doesn't a lot of the cost come from those (many times Illegal Immigrants and low income) who head to the Emergency room for every little problem? I think the rest of us end up paying for their "free" healthcare.

And I think you touched on it, the problem with socialized health care is that they believe you only deserve a certain amount of treatment. The problem is, not everyone is the same. 20 trips to the Psychologist isn't going to cure you of your addiction to GS, but it might cure someone else.

[Whirlin]

And I think you touched on it, the problem with socialized health care is that they believe you only deserve a certain amount of treatment. The problem is, not everyone is the same. 20 trips to the Psychologist isn't going to cure you of your addiction to GS, but it might cure someone else.
I don't think those concerns are exclusive to socialized health care. Employer driven plans have the same limitations in place.

[zennsunni]

You simply can't dismiss socialized healthcare as a concept. It exists, and works well in most of the post-industrialized world. And the clusterf&*k that is the ACA is fundamentally quite different from socialized healthcare. The big pharma, and even bigger hospital (true, look it up) special interest will prevent anything vaguely resembling socialized healthcare anyway, regardless of the president.

[Soulance]

HMO's kind of started it off years ago and Obamacare picked it up. It's fine for many. Obamacare banks on the fact that most people won't need/use it.

And I can dismiss socialized healthcare, but understand parts of it have value.

Drug makers don't need to make $750 a pill and doctors don't need to charge all that money - but they still do. Kind of like they are putting out a high bill in hopes to get a higher settlement payment in the end. If they said $100 a visit, they'd probably only get $20 if that. Saying they want $1000 might net them $250.

[~Rocktar~]

With doctor effectiveness and ratings, you're going to get people who complain that things aren't "fair" and that they can't afford getting the "good" doctors. Doesn't a lot of the cost come from those (many times Illegal Immigrants and low income) who head to the Emergency room for every little problem? I think the rest of us end up paying for their "free" healthcare.

And I think you touched on it, the problem with socialized health care is that they believe you only deserve a certain amount of treatment. The problem is, not everyone is the same. 20 trips to the Psychologist isn't going to cure you of your addiction to GS, but it might cure someone else.

People don't want to afford the good doctors now either. Yes a lot of ER vists are not emergancies and despite a lot of perception many ER and Urgent Care visits are by people who just don't want to be bothered to wait for a regular doctor visit. And the issue with mental health and substance abuse treatment is that there are a vast number of treatments that have marginal effectiveness at best. In addition there is a large number of mental health "professionals" who milk the system for all they can simply because they refuse to accept the idea that there is a degree of evidence based medicine that can be applied. The substance abuse field is particularly rife with BS treatments and plans and facilities again because the field doesn't want to use evidence based medicine practices.

[Soulance]

In addition there is a large number of mental health "professionals" who milk the system for all they can
This is one of the reasons I'd love to see the Govt privatize many of the things they are "responsible" for right now. Ditch most everything and cut taxes a huge amount after the debt is paid off. Use just enough money to hire people/companies to oversee those items they once controlled (welfare, Obamacare, etc)

The only thing I'd like the Govt to fund personally is our Military - and focus more effort on making that right with spending leaks as well as helping out NASA.

The system has been in far too long and too many people know how to milk it. It's leaking everywhere and we're hemorrhaging monies in too many places.

[everan]

The reason there is the so called "dual pricing" is because insurance companies offer providers a contract that says we will send our people to you in exchange for a substantial discount on your services. The provider gets more business and knows the insurance company will pay so they make more money at a lower individual cost. If they reply on people off the street, they don't know if or when they will have business, they don't know if or when they will get paid and they have to absorb the losses for those that don't pay. This is the same thing other companies do with supply train contracts. Health care providers aren't required to sign on and many many do not. In fact, most all anesthesiologists are not in contract with ANY insurance company.


Oh, I totally understand the dual pricing concept, but a substantial discount is 5-10%, not 75%. To offer the same service to one class (insured) at literally 1/5 the cost to another (uninsured) smacks of predatory pricing. And, in my opinion, the real reason this happens is because the government sets the price through Medicare. Everyone else just lines up in order of market power.

Next, the hospitals almost always get paid some way when they treat indigent people. It's the poorly insured people that pose the greatest risk. It's the difference between what a patient has to pay out of pocket and when the insurance kicks in that creates the risk. And that differential is growing, or at least it has been at my company the past couple years.

As for anesthesiologists, that's another big problem. How dare you show up without my permission (as you're putting me asleep) and perform a service and then say, hey, tough luck, I don't participate in your insurance plan? If you don't participate in the largest insurance program in the state, then it's on you to make payment arrangements IN ADVANCE with me. Guess what, I'll choose someone else.

Lastly, why is it that everyone seems to complain that the poor are creating some type of huge drain on the system by showing up at emergency rooms for service? Shouldn't the real question be why the emergency room is so expensive? Shouldn't higher volume create lower cost? Shouldn't lower wage workers, such as Interns (working insane hours on salary), and access to an array of shared equipment reduce costs? It seems anti-intuitive.

[Latrinsorm]

This is one of the reasons I'd love to see the Govt privatize many of the things they are "responsible" for right now. Ditch most everything and cut taxes a huge amount after the debt is paid off. Use just enough money to hire people/companies to oversee those items they once controlled (welfare, Obamacare, etc) The only thing I'd like the Govt to fund personally is our Military - and focus more effort on making that right with spending leaks as well as helping out NASA. The system has been in far too long and too many people know how to milk it. It's leaking everywhere and we're hemorrhaging monies in too many places.Don't you think the existence of such a system implies that privatization failed in the past? Consider the FDA, if you will: we tried the free market thing for regulating food and drugs, it was a catastrophic failure, so the government stepped in.

Regarding taxes, I have just now made a graph of the income tax rate (http://taxfoundation.org/article/us-federal-individual-income-tax-rates-history-1913-2013-nominal-and-inflation-adjusted-brackets) on a married filing jointly return of $200,000 AGI (inflation adjusted) from 2013-1955, and here is how it looks:

http://i.imgur.com/4DjVFiI.png

We have already cut taxes a huge amount, wouldn't you agree? Perhaps that is the fundamental source of our government's money woes.

[Warriorbird]

I'm glad the Trump half of the electorate likes it.

[Soulance]

Isn't the tax rate for married couples of that income 28% nowadays? The government is, in effect, getting more money than ever before so why are we more and more in debt? Something is VERY screwed up.

I think the woes are from the Govt picking up too many things.

[Gelston]

Trump talked about his dick size live on national TV.

[Soulance]

And the FDA was created as a watchdog group, which I'm okay with. That was my point. The Govt doesn't make the drugs. The Govt should just have people to keep things honest. And those people should be moved to different areas throughout their careers randomly so they have a less of a chance of being bought out/corrupted.

[Taernath]

Trump talked about his dick size live on national TV.

Was it yuge?

[Gelston]

Was it yuge?

He said there are no problems down there.

[Latrinsorm]

Isn't the tax rate for married couples of that income 28% nowadays?No. That's the highest tax rate they pay, but it only applies to the income over $146,400, so...
10% * $17,850
+15% * ($72,500 - $17,850)
+25% * ($146,400 - $72,500)
+28% * ($200,000 - $146,400)
= $43,465.50
/ $200,000 = 21.7%

By comparison, in 1988 the highest rate was also 28%, but it applied to income over $57,738 (inflation adjusted) so the actual rate paid was closer to 28%:

15% * $57,738
+28% * ($200,000 - $57,738)
= $48,494.06
/ $200,000 = 24.2%
The government is, in effect, getting more money than ever before so why are we more and more in debt? Something is VERY screwed up. I think the woes are from the Govt picking up too many things.Our taxes are lower than they've been at any point since World War II. Proposing a tax hike is political suicide, rabble rousing that the government is spending too much (and then doing absolutely nothing to curb it) is a bottomless political well, especially when you can couch it in terms of what the other side is spending on. Cui bono, Soulance, cui bono.