On Donald Trump’s first day as president, he signed what White House Chief of Staff Reince Priebus described as: “An executive order minimizing the economic burden of the Patient Protection and Affordable Care Act pending repeal.”
“Repeal and replace” is the GOP’s mantra for their vision of health care in America. After 60-plus attempts to “repeal” the Affordable Care Act, they have that part of the mantra down cold. As for the “replace” part ― not so much.
On Jan. 15, in a Washington Post interview, Trump said that Obamacare would be replaced with “insurance for everybody,” and that health care offered under his plan would come “in a much simplified form — much less expensive and much better.”
Trumpcare sure sounds wonderful, though there are no specifics on how that much simpler, much less expensive, much better insurance for everybody plan actually works. When pressed for details on his plan, the president replied that “It’s very much formulated down to the final strokes. We haven’t put it in quite yet but we’re going to be doing it soon.”
Waiting for America’s new health care plan is every bit as suspenseful as an “Apprentice” pre-commercial break cliffhanger. The anticipation is killing us – maybe literally.
Unfortunately, by Feb. 27, it looked as though our president might actually be a few strokes short of a full plan, exclaiming, “Nobody knew health care could be so complicated.”
Just in case Trumpcare isn’t quite ready for prime time, I’ve come up with my own plan for consideration. As it turns out, health care in America might not need to be quite so complicated after all.
To begin, here are a few facts that will be useful:
According to the Organisation for Economic Co-operation and Development (OECD), in 2015, the average annual cost of health care per person in the United States was $9,451. For that annual price tag, Americans can expect to live an average of 79.3 years – 31st place in longevity among our global neighbors.
At the other end of the lifespan spectrum, citizens in the top ten healthiest countries can expect to live an average 82.25 years – nearly three years longer than their American counterparts.
Here’s the kicker: the median annual cost of health care per person in the top 10 countries is only $4,150:
So… the top 10 healthiest countries spend less than half of what the U.S. spends on health care, and their citizens live three years longer.
Here’s another interesting piece of trivia: in 2015, U.S. government spending on health care topped $2.1 trillion, or $6,496 per person. And even though the U.S. spends 57 percent more than the 10 healthiest countries do to provide their citizens with premium-free healthcare, our citizens still shell out a boatload of money on insurance, co-pays, and out-of-pocket costs.
If it seems like something is wrong with this picture, that’s because something is. For what we’re already paying out in taxes, we should be able to get healthcare that’s at least as good as the top 10, with $0 in insurance premiums and $0 in co-pays.
So what’s the solution? The same kind of single payer, government-run healthcare that delivers longer life at lower cost for the top 10 countries is not an option for the U.S. As we know, in America, ensuring the health of insurance companies trumps the health of people. Besides, those that say a government-run health care system would be run like the VA might have a point.
If single payer isn’t an option, what is?
Here’s the crazy idea: give everyone a health care debit card with a government-funded allowance and let them spend it however they like at any valid health care provider or pharmacy. No claims. No forms. No permission. No fights with insurance companies. The allowance would be based on the same actuarial tables used by the insurance industry – in short: young people get less. Old people get more.
Here are some advantages of debit card health care:
1. It eliminates insurance-related health care administration. Did you know that doctors and hospitals spend nearly half a trillion dollars annually on billing and insurance-related bureaucracy? It’s easy to understand why – doctors and hospitals must dedicate staff to work through an endless maze of insurance provider bureaucracy in order to fight for their patients’ claims. Additionally, staff is required to prepare and send bills, do collections, and process payments. If all payments happen via debit card at the time of service, and no insurance approval is required, 15% of the total cost of health care disappears, driving our $9,451 annual per-capita cost down to $7,911.
2. It gets rid of insurance company overhead, profit, and marketing. Cigna CEO David Cordani’s compensation jumped 19% in 2015 to $17.3 million. It seems he couldn’t scrape by on the meagerly $14.5 million he was paid in 2014. How did Mr. Cordani earn that raise? Trust me – it wasn’t by saving a life. The CEOs of the top five insurance companies all pull down eight figures. That money, along with all insurance corporate profit, administrative and marketing costs is ultimately absorbed by you.
3. It introduces market-driven pricing and value. At the very heart of our insurance-centric system lies the argument that capitalism delivers superior health care compared with socialized systems like the ones where people live longer and pay less. A market-driven system might indeed provide the best health care for the greatest value if we actually had a market-driven system. America’s insurance oligarchy doesn’t facilitate the exchange of services between health care providers and their consumers as much as it insulates them from each other. Where is the “Kayak” for health care that enables you to price shop for procedures among doctors with the best ratings? Where is the Trivago that enables you to comparison shop online for prescription medications from other countries where they’re cheaper? For example, as reported by The Wall Street Journal, a vial of the cancer drug Rituxan will set you back $3,678 in the states, while Norwegians pay less than half – $1,527 – for the same drug. One prerequisite needed for the Trivago for meds is for the U.S. law against international drug shopping to be lifted. The pharma lobby is not too keen about seeing that law go away. Richard Evans, a former pricing official at drug maker Roche Holding AG noted that “The U.S. is responsible for the majority of profits for most large pharmaceutical companies.”
A true market-driven health care system would yield the same kinds of values as market-driven systems for other products and services, enabling the United States to realize similar efficiencies that most other major countries discovered many years ago.
I’m anticipating some questions about debit card health care:
Q: What’s to stop someone from spending their allowance on something nonessential, like cosmetic surgery?
A: Absolutely nothing. As long as the allowance is spent at an approved doctor’s office, hospital, or pharmacy, the patient can buy whatever they like. However, once the patient exhausts their annual debit card allowance, they’d need to whip out their own credit card to pick up the slack. The central tenet of debit card health care is that patients, not insurance companies, make the decisions about patient health care spending.
Q: What about people with cancer who spend more than the average? What about people who get hit by a bus?
A: The average costs discussed in this article are totals, inclusive of extraordinary expenses. I propose that a percentage of the average allowance be carved out for a pool for these specific conditions. This would, in effect, be a socialized aspect of the plan; enabling 100% coverage for those exempted conditions.
Q: What if I really like paying outrageous premiums and co-pays, battling with my insurance company and worrying about whether a procedure will be covered? Can I still keep my insurance company?
A: Battle on. Americans who love their insurance providers can go right on loving them. Debit card health care would be another choice in the spectrum of offerings that would potentially enable citizens to obtain the same taxpayer-funded health care our elected officials have enjoyed for decades.
Debit card health care offers something for everyone. For Americans desiring affordable health care, they’re covered. For those who believe the free market is the answer to all the world’s problems, this approach offers a much freer health care market than the one we have today. It even offers something for insurance companies, who, for years, have argued the superiority of capitalism over socialism, yet have lacked any real competition that would enable them to prove their point. Debit card health care would solve that problem in a hurry.