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  1. #1
    Senior Member Judy's Avatar
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    Donald Trump’s Health Care Ideas Bewilder Republican Experts

    Donald Trump’s Health Care Ideas Bewilder Republican Experts

    By ROBERT PEAR and MAGGIE HABERMAN APRIL 8, 2016

    WASHINGTON — Donald J. Trump calls for “a full repeal of Obamacare” but says that “everybody’s got to be covered.” Initially, he liked “the mandate,” a central feature of the Affordable Care Act that requires most Americans to have insurance or pay a penalty, but he backed off that position under fire from conservatives.

    He would allow people who purchase insurance on the individual market to take tax deductions for their premium payments. But aides acknowledge that this tax break would not be worth much to people whose income is so low they pay little or nothing in federal income taxes. For them, Trump aides say, there would be Medicaid, which the billionaire businessman says he would not cut but would turn into a block grant to state governments.

    This whipsaw of ideas is exasperating Republican experts on health care, who call his proposals an incoherent mishmash that could jeopardize coverage for millions of newly insured people. But for Mr. Trump’s campaign, such criticism appears only to bolster the candidate’s outsider status. His chief policy adviser, Sam Clovis, said Mr. Trump was running against the political establishment in Washington and was therefore not relying on advice from “traditional establishment Republican people.”

    Instead, Mr. Clovis said in an interview, Mr. Trump is receiving advice on health care policy from at least half a dozen “very prominent people,” but he declined to name them. “They are not ready to have their support of the Trump campaign known,” Mr. Clovis said.

    Some experts outside Mr. Trump’s campaign have been unsparing.

    “If you repeal the Affordable Care Act, you’ve got to have a serious way to expand coverage to replace what you have taken away,” said Gail R. Wilensky, who was the administrator of Medicare and Medicaid under President George Bush from 1990 to 1992. “There’s nothing I see in Trump’s plan that would do anything more than cover a couple million people.”

    Robert Laszewski, a former insurance executive and frequent critic of the health law, called Mr. Trump’s health care proposals “a jumbled hodgepodge of old Republican ideas, randomly selected, that don’t fit together.”

    Mr. Clovis, the national co-chairman of the Trump campaign, acknowledged that the ideas Mr. Trump has offered to replace the health law were just “a starting point,” a framework. He said Mr. Trump would have a detailed, comprehensive plan to replace the law if Congress repealed it, and added that any replacement “must be bipartisan.”
    Asked if Mr. Trump’s plan would insure all those who have gained coverage under the health law, Mr. Clovis said: “That might be correct, but we really don’t know that. A lot of it depends on what initiatives we can get through Congress.”

    Mr. Trump’s health policy can be pieced together from speeches, television interviews, Twitter posts and a seven-point plan, titled “Health Care Reform to Make America Great Again.” He says Congress should encourage the sale of health insurance across state lines and allow individuals to take tax deductions for insurance premium payments. His Medicaid proposal would send lump sums of federal money to each state to provide health care to low-income people, although unlike other Republicans, he has vowed not to cut overall Medicaid spending.

    That Mr. Trump’s ideas confound Democrats is no surprise. More interesting are the acerbic comments of serious students of health policy often aligned with Republicans.

    Mr. Trump’s health care platform “resembles the efforts of a foreign student trying to learn health policy as a second language,” said Thomas P. Miller, a health economist at the American Enterprise Institute and a harsh critic of President Obama’s health law.

    Millions of low-income people have gained coverage under the Affordable Care Act and could lose it if Congress repealed the law. Mr. Trump’s proposal for a tax deduction for premium payments would not help them much, Mr. Miller said, because they do not pay much in income taxes.

    Sam Clovis, Mr. Trump’s chief policy adviser, has acknowledged that Mr. Trump’s ideas to replace the Affordable Care Act are a framework.

    Mr. Clovis called that “an excellent point,” and he suggested that low-income people could obtain coverage through Medicaid — even as Mr. Trump seeks to slow the growth of Medicaid spending with a block grant. At the same time, Mr. Clovis said, some workers with employer-sponsored coverage might prefer to take the tax deduction and buy health insurance on their own.

    “The trend will eventually be that employers will provide income to buy insurance on your own, and the employers will get out of the group policy business,” Mr. Clovis said. This trend, he said, could help workers who are now “held captive by their benefits in a business or company they work for.”

    James C. Capretta, a senior fellow at the Ethics and Public Policy Center, a conservative nonprofit group, said Mr. Trump underestimated how difficult it would be to uproot a law that was now embedded in the nation’s health care system.

    “It took a herculean political effort to put in place the Affordable Care Act,” said Mr. Capretta, who worked at the White House Office of Management and Budget from 2001 to 2004. “To move in a different direction, even incrementally, would take an equally herculean effort, with clear direction and a clear vision of what would come next. I just don’t see that in Trump’s vague plans to repeal the law and replace it with something beautiful and great.”

    Many of the proposals Mr. Trump has embraced have been Republican standards for years, such as allowing insurers to sell their products across state lines. In a debate in Houston in late February, Mr. Trump said repeatedly that he wanted to “get rid of the lines around the states,” and he explained: “Instead of having one insurance company taking care of New York, or Texas, you’ll have many. They’ll compete, and it’ll be a beautiful thing.”

    But Mr. Laszewski, the former insurance executive, said this was no panacea. Before a Texas company could, for example, sell insurance in New York, he said, it would need to establish or “rent” a network of doctors and hospitals to meet the needs of consumers.

    Moreover, state insurance officials have resisted such legislation, saying it could undermine their power to regulate insurance and their ability to protect consumers.

    Grace-Marie Turner, the president of the Galen Institute, a champion of free-market health policy, said Mr. Trump’s proposals were sketchy and inadequate.

    “He has to discard some of his ideas, like the importation of prescription drugs, because they would be damaging and unworkable,” Ms. Turner said. “And he has to flesh out his other proposals with much more detail if he hopes to persuade voters that he has a credible plan to replace Obamacare.”

    Mr. Trump has called for removing barriers to imported drugs from other countries, such as Canada, saying it will lower drug prices and offer consumers more options. Democrats have long embraced the idea but have been blocked by pharmaceutical industry opposition as well as concerns over drug safety.

    Mr. Trump’s views have evolved. Writing about health care in his 2000 book, “The America We Deserve,” he said, “I’m a conservative on most issues but a liberal on this one,” and he expressed interest in the idea of a “single-payer plan,” with consumers free to choose from competing private options. He backed away from that idea in an interview with The New York Times in 2011, when he was flirting with a White House bid and his conservative credentials were under scrutiny.

    A populist theme still runs through many of Mr. Trump’s statements. “The insurance companies are making a fortune because they have control of the politicians,” he said in a debate last year. For a similar reason, he says, drug companies get away with overcharging consumers.

    Mr. Trump says Medicare should be able to negotiate prices with pharmaceutical companies — a proposal embraced by Democrats and blocked by Republicans in Congress for more than a decade — and he promises that if elected he would “negotiate like crazy.”

    http://www.nytimes.com/2016/04/09/us...care.html?_r=0
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    Senior Member Judy's Avatar
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    No Republican should be "confounded" or "exasperated" by Trump's health care plan. It's as simple as it can be. It's complete with natural normal cost-cutting plans as well as fairness for those who can pay and compassion for those who can't.

    The plan involves getting rid of the "lines" between states by repealing the McCarran-Ferguson Act of 1945 which open up interstate transactions and increase competition. This allows for a normal nationwide enterprise, like every other business in the US, affording savings and higher efficiency levels, innovation, creativity, customer convenience and competition. This also subjects this massive industry to regulation by the Federal Trade Commission and the Sherman Anti-Trust Act. Presently the insurance industry is exempt from federal regulation and the Sherman Anti-Trust Act because of the McCarran-Ferguson Act of 1945.

    When Trump said he liked the "mandate", he was talking about the mandate that prohibits denial of coverage for pre-existing conditions. I saw the interview and that's what was being discussed when he said he like the mandate. Trump has never supported forcing anyone to buy health insurance.

    The health insurance is famous for coming up with terms that no one else understands. Take the term universal health care plan. To most people like me this is a universal plan that like a basic plan covers all the important fundamental elements of health coverage. If you want something more then you could purchase one of the more comprehensive or creative plans or conversely choose one that is less so.

    Another term that they use is "single payer system" which means something entirely different than what I thought it meant. I thought it meant a single customer, an individual based system, versus one that relies on group plans. But in insurance lingo it apparently means the government.

    Trump's plan is for private plans not government plans, but for Medicare and Medicaid. He likes both Medicare and Medicaid and wants to keep them. I agree with him. He also wants to expand Medicaid or develop an alternative plan through not-for-profits or government to hospital arrangements to provide care for those who can't afford it but for whatever reason don't qualify for Medicaid. And I agree with this. Over $1.3 trillion a year is siphoned out of the US economy into 501 C 3's. And that figure was several years ago so it's probably far more by now. At the time is was approximately 10% of the US economy, yet we have millions of homeless people, 75 million people on Medicaid and 46.5 million on food stamps. So the 501 C 3 "charities" aren't using their tax status to provide "charity", otherwise, the government wouldn't have hundreds of billions of dollars a year spent on doing the "charity" that the 501 C 3's should have addressed with their $1.3 trillion of tax exempt revenue.

    501 C 3 status should be limited to "charity" which should be defined as or directly related to feeding the hungry, sheltering the homeless and healing the sick free of charge.

    This simple change in the law would go a long ways to restoring the real meaning of the term "charity" in our language and would make charity money available to solving our most important issues. The goal should be to move at least 30 million of food stamp recipients from federal beneficiaries to charity organization assistance, picking up all those who are not eligible for Medicaid but can't afford hospital care, and reducing the number of Medicaid beneficiaries by 50% from 75 million to less than 37 million.

    This would straighten out major kinks in our system for the poor while we work diligently to streamline the system through nationwide interstate competitive insurance plans.

    Additionally, over 80% of our hospitals in the US are 501 C 3's who are presently responsible for the exorbitant cost of medical care which pushes the high rates of insurance to cover the costs. Something is very wrong with this picture. So there needs to be a revamp of this system, the hospitals privatized and modernized. The tax exempt status was granted to provide "charity", and they aren't doing that. There is no "charity". They bill insurance companies, bill the patients when they don't have insurance, bill the government, and hound for payment, the same as any other business. Yes, they provide up to 17% free service to keep their "status", but bill the underage to other customers who paid for their services. This is all wrong, all the way around, because there is no "charity" involved here and is basically a fraud.

    So, the best course would be to reorganize all these hospitals into for-profit corporations and if they want to have a "charity" component, then have a "charity" component that their corporation pays for, not their customers or insurance companies or something along those lines, or an actual charity 501 C 3 covers for them.

    When illegal aliens are deported, immigration is paused and our manufacturing jobs start coming back to the United States, the number of people who need Medicaid or "charity" because they can't afford health insurance will dwindle to a small number of folks that our "charity" system should be able to handle nicely. Sure we will still need Medicaid, but not for 1/4 of our legal population, more like 1/10th.

    All of our problems with poverty and health care is actually related to the unemployment and lack of jobs that provide sustainability. We solve the immigration and trade issues, and most of the other problems will self-correct very quickly. This is what Donald Trump understands which no other candidate has or does and why he's the one to get behind, because he wants to solve these problems at the source which why these "Republican experts" on insurance are "confounded" and "exasperated".
    Last edited by Judy; 04-09-2016 at 05:47 AM.
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    “The insurance companies are making a fortune because they have control of the politicians,” he said in a debate last year. For a similar reason, he says, drug companies get away with overcharging consumers.

    Mr. Trump says Medicare should be able to negotiate prices with pharmaceutical companies — a proposal embraced by Democrats and blocked by Republicans in Congress for more than a decade — and he promises that if elected he would “negotiate like crazy.”


    You can bet Big Pharma is one of several greedy players that are trying to eliminate Trump.

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