DIP... I am more disappointed in Trump's lack of involvement in this debate, than I am in the actions of the moderate Republicans. I think there is an opportunity to do something really meaningful and long lasting in this area, but it requires Execustive leadership from Trump. Let's deal with reality. Obamacare has moved the needle in American expectations for healthcare: we generally think everyone should have access to affordable healthcare, those less fortunate should have government help with the premiums, pre existing conditions should not preclude affordable coverage, and insurance companies shouldn't receive huge government subsidies to participate. We also don't like the individual mandate or the employer mandates or the prescriptive level of insurance coverage. Most of us are ignorant of the extent to which Obamacare expanded Medicaid to the working poor for the twenty or so States that chose to accept this, but this is a real budget killer and the States that opted for the expansion are NEVER going to support reform that cuts the federal bucks to them for this.
I'm probably in the minority of those who post here, but I would like to see Trump propose a radical new approach. Something along the lines of:
1. Allow insurance companies to offer whatever mix of benefits and costs they want. Do Not require coverage for pre existing conditions or removal of coverage caps, etc... in other words, allow insurance to work as insurance like it is supposed to in a market economy.
2. Allow insurance companies to sell across state lines, but also require that they create exchanges that offer group rates to individuals. This should be left to them to decide how to bundle these...by geography or industry, etc...
3. Provide a Public Option ( the liberals holy grail for a single payer system ) that anyone can buy, patterned after Medicare for seniors except for requiring some level of co pays and deductibles, that covers pre existing conditions and operates without a cap, etc...
4. The Public Option has to be self funded and premiums adjusted annually just like the private sector insurance companies. Government assistance for the premiums will be provided on a needs based system.
5. Everyone would be required to have health insurance. Employers would be required to collect the premiums under either option. For those opting for the public Option, premiums would be deducted from their pay as part of the payroll taxes currently deducted.
6. Employers would be required to offer insurance, whether through private insurance companies or through the Public Option or through the exchanges, and those decisions will be part of the benefits package they offer to compete for the best employees.
The Public Option would be loved by the Dems, and hated by the Repubs, and safeguards would have to be placed to ensure it is self funded by premiums (some with government assistance) and essentially compete in the market place. For those who argue this is the first step to socialized medicine, I would argue that we are long past that and Medicaid and Medicare are already servicing a significant portion of our population. Our private sector insurance companies should thrive under a free market environment. This would not be inexpensive, that is the government assistance for the needy, but the reality is we are already spending huge amounts of resources in a very inefficient hybrid approach that ruins the efficiencies of a market economy approach; and I personally think it is good public policy to ensure healthcare for everyone.
My last thought is for Trump to be the deal maker he is, and put something like this together, but add in a huge kicker for conservatives, and that would be to offer this in conjunction with a school choice voucher system. There are aspect of this for liberals and conservatives to love and hate equally. I appreciate this is a very complicated issue with deep felt principles at play,, and that's why someone like Trump can in fact make a difference if he steps in and presents a compelling alternative that has cross Party likes and dislikes, and then use the bully pulpit to sell his program to he Public. Sorry for the rant!
