And that could be the start of something big – really big. “Instead of going to the insurance companies, I want the money to go into an account for people where the people buy their own health insurance,” Trump told Fox News, calling his plan “Trumpcare.”
“The insurance will be better. It will cost less. Everybody is going to be happy. They’re going to feel like entrepreneurs. They’re actually able to go out and negotiate their own health insurance.”
The problems with health care have long been the sometimes-perverse incentives built into the system. Insurance companies charge premiums and decide what they will or will not cover. Given ever-rising costs, doctors who prescribe drugs or procedures are met by the inevitable question from patients: Is it covered by my insurance? If it is, then they will consent to it – whether it is truly necessary or not. Doctors are motivated to overprescribe in order to protect their flank and assure they will not be accused of malpractice, for which insurance costs are astronomical. It’s called defensive medicine, and it is a major factor in the soaring costs of health care.
At the same time, according to Psychology Today, “doctors often feel pressure from patients to provide antibiotics, and they identify this pressure as a major reason why they frequently prescribe them for illnesses that do not respond to antibiotics.” Various studies also suggest that doctors who receive money from drugmakers for a specific drug, a common practice, will prescribe that drug more heavily.
Barack Obama and Democrats kicked the can down the road by frontloading Obamacare benefits and backloading much of the massive funding required to keep the ACA afloat over time. But in the 14 years since the passage of the ACA, Republicans have failed to present a viable substitute for the quasi-nationalization of health care. The problem is not that they’ve come up with no alternatives, but that they have come up with too many, and have thus failed to reach anything approaching a consensus. They came close to gutting the ACA in 2017, but the late Sen. John McCain broke from his Republican colleagues and – driven by his personal animus towards Trump – cast the deciding vote against repeal. The other ripe opportunity to replace Obamacare was deep-sixed in 2012 by Supreme Court Chief Justice John Roberts, who refused to go along with the four other conservative justices at the time, leaving the program in place. In 2020, the Court again refused to budge.
Go Big or Go Home
ACA deductibles of up to $10,000 annually make the plan virtually useless for low-income individuals unless they are the victim of a serious medical emergency. The alternative would be a dramatic expansion of HSAs combined with low-cost, high-deductible catastrophic insurance plans, allowing patients to control their own health care while reversing the incentives for doctors to overprescribe, thus lowering costs.
A majority of Americans originally were opposed to the Affordable Care Act, but like any government entitlement program, people get attached to it. As Ronald Reagan once famously said, the closest thing to eternal life on earth is a government program. Such has been the case with Obamacare, which Democrats originally had to work around the clock to pass by a single vote, and which they now defend to the death despite its clear lack of sustainability absent huge government subsidies.
The time is finally ripe for President Trump and the GOP to advance a long-awaited free-market Republican alternative to the ACA. And specific legislation on how to achieve it is in the offing. Rick Scott, Republican senator from Florida and a former health-care executive, says he is “writing the bill right now.” Presented with an opportunity to finally break the Obamacare fever and do more than just complain and obstruct, Republicans would do well to follow the well-worn expression, go big or go home.
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