Republican Health Care Reform Plans Are Getting Less Comprehensive And Less Acceptable

To borrow a line from Hamilton, the musical, [Republicans are having their] "governing is harder moment" with health care reform. Just this week they added two more health care reform proposals (outlines) to the seven they conjured up since 2009. The latest health care proposals are near opposites of each other and include an Affordable Care Act (aka Obamacare) light plan and a worse than before Obamacare plan with no subsidies, or possibly, insurance for the sick and poor.

The Road To Still No Health Care Reform Bill

Whenever Obamacare opponents provide an Obamacare alternative plan, its contents are 90% Obamacare is an abject failure, and 10% (usually a bulleted list), here's my plan. Because the focus is not on reforming America's complex and pricey health care and health insurance sectors, their plans come up short in money, benefits covered and access, when compared to Obamacare. This opposition-focused exercise that Republicans are engaged in has produced nine proposals so far.

  • The Obamacare Replacement Act
  • Patient Freedom Act
  • The American Health Care Reform Act
  • The Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act
  • Health Care Choices Act
  • A Better Way, To Fix Health Care (Reform Plan)
  • The Patients' Choice Act
  • Health Care Freedom Act
  • Empowering Patients First Act
So, from 2009 to 2017, Republicans have been unable to agree on a unified health care reform plan. But this week they are meeting in my hometown of Philadelphia to map out their policy agenda. According to leaked photocopies of the retreat agenda, there was a Thursday morning session labeled Keeping Our Promise On Health Care. And unless some waiter recorded this session, we probably won't know for some time what Republicans plan to do with American health care. Will they agree on a unified reform proposal—there's no shortage of them, including the two announced just this week? Will they, as Trump mused, wait to see if Obamacare explodes and then "rush" to fix it in 2018, after the mid-term elections? Or will they propose a series of health care reforms stretched out over several years? And will these reforms be more health care or health insurance-centric?

More Words Don't Equal More Coverage

Republicans' Obamacare replacement plans are all over the map. Some focus on health care and health insurance reform together, others one or the other. At first glance, they seem to be growing further apart. But look closer at the latest alternative from Senator Rand Paul, the Obamacare Replacement Act, and you may find several similarities to the plan Congressman Tom Price, proposed in 2009. The Secretary of Health & Human Services nominee, Price, is credited with proposing one of the most comprehensive Obamacare alternative plans, the Empowering Patients First Act. Paul's plan is short on details, but he and Price have the same or similar philosophy about American health care policy. The Acts similarities are notable. For one, both authors are physicians, but the similarities don't stop there.
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Tom Price Wants Individual Health Insurance For All, That's Not Universal Health Insurance

Two days before the U.S. presidential inauguration, Senator Bernie Sanders asked Secretary of Health and Human Services (HHS) nominee, Tom Price, "do you believe that health care is a right of all Americans, whether they are rich or they're poor." Like any worthy opponent, Price would not give a "yes" or "no" answer. Instead, he said, "I look forward to working with you to make certain that every single American has access to the highest quality care that is possible.” Here's how I interpret Price's cold reply:

Americans that can afford to pay for the highest quality health care shall have access to it. Americans that cannot afford the highest quality care shall have access to the level of care what little money they have can provide. A doctor is advocating for levels of care based on ability to pay. Shocker. But not all doctors are like Tom.

The Greedy Dr. Price

Tom Price has an estimated net worth of over $13 million. His HHS nomination hearing is as much
about corruption as it is about policy. There are allegations that he purchased health care stocks based on insider information and introduced legislation favorable to a company whose stock he owned. Price claims his stock purchases were legal, and that may be true, but his lack of propriety in making these purchases and their timing, is unsettling but not surprising.

Price's careers as a doctor, State Senator and U.S. Congressman have a common theme—oppose any and all legislation that threatens the paychecks of doctors. He opposed single payer health insurance long before Obamacare when he mobilized other doctors to lobby against Hillarycare. And he has a history of trying to limit, sometimes drastically, the amount patients can receive in malpractice lawsuits. With so much time and effort devoted to pursuing and sustaining wealth for doctors, the confirmation hearing may be uncomfortable, but Tom's been doing this for a long time, and he has an answer for everything.

Tom Wants A Health Care System Made Up Of Individuals

As an entrepreneur with a medical degree whose main purpose in life is to stay rich, we can expect Tom Price to oppose legislation to limit what doctors, hospitals and pharmaceutical and medical device companies can charge for their services and products. For Tom, health care is a commodity, not a right of all Americans. Other things not to get your hopes up about with a Price-led HHS department:

  • meaningful health care price transparency
  • limits on out-of-pocket health care cost for patients
  • the prohibition against balance billing
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Without Universal Health Care, Adopting Electronic Health Records Becomes Harder

In his January 6, 2017, interview with, President Obama said that one of the great disappointments for him regarding the Affordable Care Act (aka, Obmacare) was the difficulty in getting doctors and hospitals to go paperless. His interviewers, Ezra Klein and Sarah Kliff, expressed surprise that the President chose this as one of the great disappointments of such a controversial law. But I get it.

The U.S. is a world technology leader. Home to the world's largest and richest tech companies like Apple, Microsoft, Intel, Google and Facebook. But whether we are the best in tech is a matter of debate. Some believe Israel is tops in tech, claiming it has the brightest software engineers in the world, responsible for creating the best firewall software and other tech innovations. Still, others give a shout-out to Denmark, Finland, Sweden and Estonia, well known for extending tech to all of its citizens who use it in the everyday lives, even more than Americans.

But despite the great things that other countries are doing with tech, I think it is fair to say that that America has the resources and capability to lead the world in health information IT; if we wanted to. And maybe that is the primary reason that electronic health records (EHRs) are still a hope of Obama's.

What Are EHRs And What Are The Benefits and Challenges Of Using Them

Electronic health records are digital records created on a computing device by doctors and other medical care providers and staff about a patient's treatments and care. They have many potential benefits for patients and doctors, including:

  • Less paperwork—won't have to provide the same basic information to every new doctor
  • Fewer medical errors—doctors can receive warnings and alerts about allergies and prescribed drugs
  • Easier remote access that may also expand the use of telemedicine—patients can communicate with providers online and make appointments
  • Better diagnosis—doctors have a more complete and up-to-date picture of a patient's medical status
  • Less diagnostic testing—doctors can see previously ordered tests and won't duplicate unless necessary
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The Republican Alternative To Obamacare Always Has And Always Will Be, Personal Responsibility

Trump voters don't like the Obamacare subsidies or the Medicaid expansion because they help the undeserving. Consequently, they are okay with repealing and replacing Obamacare with something better, and they believe Trump can provide it because he is a businessman. Yeah, they believe that. And while I play around with the idea that Trump will surprise Republicans by proposing single payer health care so that he can brag about accomplishing something President Obama could not, the realist in me expects a plan similar to the alternative "plans" already offered up by Republicans. And the overarching theme of all of these plans is, personal responsibility and nothing says personal responsibility like putting aside your money to pay for your out-of-pocket health care expenses. You don't need subsidies. You just need a good tax deal to help you better use the money you should have. And that's why Republicans love health savings accounts (HSAs) so much.

Health savings accounts (HSAs) allow individuals to set aside money in tax-favored accounts to pay for medical care and prescription drug expenses. So, in addition to paying health insurance premiums, deductibles, coinsurance and copays, you can put some "extra" money in a tax-free HSA account. Think of HSAs as the health insurance version of the 401(k) retirement savings plan. Before 401(k) plans, employers provided pension plans to workers and their retirement benefits were pretty much guaranteed. Employers typically financed these plans but some plans required small employee contributions—it was an employer responsibility or a shared responsibility between the employer and employee. Then came the 401(k) plan with its risk of losing money, high finance fees, and employee-only or employee-mostly contributions. Responsibility shifted.

And how has the retirement income responsibility shift worked out? Well, just the other day, the Wall Street Journal reported that many supporters and early adopters of 401(k) plans acknowledge that they were mistaken in its benefits. Continue Reading...