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Trumpcare – Do we need a public comment period?

January 16, 2017

Do you care what kind of law or plan replaces Obamacare? If so, keep reading.

As noted here in a previous post, Senator Rand Paul has, as promised, been first to the mark with a version of a replacement for Obamacare. President-elect Trump says he will roll out his plan soon, probably after he is inaugurated.

Previewing his plan on Fox News, Senator Paul noted that parts of the ACA that people like, i.e. insuring grown children until age 26 and covering pre-existing conditions will be a part of his bill, because “…they are part of the underlying law.”

The rest of it was just bullet points; the actual bill is supposed to be out later this week.

Frankly, it didn’t sound all that transformational but hey, let’s give him a chance. At least he has something to show for all the hot air that’s been expended on this topic for the past six years.

That doesn’t mean that we shouldn’t try to find out what Congress is going to stick us with next.

One thing that was bothersome was his reference to the underlying law. Isn’t that supposed to be what we want repealed?

From the sounds of that remark, it sounds like all we’re going to get is a tweak in the phone-and-pen rulemaking.

The problem with just trying to tweak Obamacare is that it was based on faulty logic and unbelievably poor math from the get-go.

Just removing the one-size-fits-all policy choices is nice, as is broadening the market across state lines to increase competition and restructuring Health Savings Accounts (HSA).

If that’s all there is, it won’t work.

What about the 29-hour work week, and the tax on those that still can’t afford a policy but make just a bit too much for Medicaid? What about the tax on medical devices and “Cadillac” health plans? What about medical providers demanding that the deductible be paid up front?

Obviously there’s going to be a lot more to any replacement plan than three bullet points, but this preview shows a drastic lack of imagination.

Remember us, the people?

In the movie Patriot’s Day, Mark Wahlberg’s character begs his superiors to involve the entire city of Boston in the search for the bombers by releasing the pictures they have. We know what happened after that.

It works in today’s world too.

Someone besides doctors, lawyers and other assorted lifetime politicians should have input on whatever comes after Obamacare.

How about posting the bill, in plain English, on the dot gov website for 30 days, and let people read and comment on it? Believe it or not, there are some people out here that might actually have some better ideas. Then take another 30 days to actually read and digest the best ideas.

Oh yes, and trot out the math on this thing before you cram it down our throats this time. Believe it or not, some people out here are pretty good at basic math.

The country can’t even afford Medicare and Medicaid under the current funding model, so why not change the model by adding from 1%to 3% to the FICA tax with the increase specifically earmarked for Paulcare or Trumpcare, (not the general fund) or whatever the thing gets nicknamed?

Yeah, yeah, it’s another tax, but assuming we all get income tax relief, it isn’t that onerous, and the cost would be shared by both the wage earner and the employer.

You get what you can pay for, and the current funding model isn’t working worth a darn.  Broadening the financial underpinnings would help keep premiums down, and hopefully remove some of the upward pressure on premium costs year-to-year.

Or, how about blending the old way and the new, with the government only picking up the tab (via Medicaid)for the poorest and sickest patients, and “encouraging” the insurance industry to offer a wider range of plans with ala carte benefits and pricing, similar to the way individual plans used to work.

That would relieve the insurers of the heartburn of having only sick people buying policies, and still keep care available to those who need help the most.

How about planning for the worst case scenarios instead of the best? You can’t give people tax credits or subsidies or send block grants to the states if you have no more money.

Even if we do get 4% growth in the GDP, that never lasts forever. When the next recession hits, and one does about every 8 to 10 years, how do the tax credits get paid then?

The reason the ACA is failing is because apparently no one, especially the CBO,  could add and multiply ordinary numbers. Either that, or in their rush to pass the thing so we could find out what was in it, no one cared.

No matter what anyone says, your can’t go operational with a new government health insurance plan much before 2019.  Insurance companies need at least that much lead time to get their end of it in place.

And that’s assuming the new plan is actually done right the first time.

Surely  President Trump wants this thing to work this time. Even if you only get Obamacare  repealed and something new in place in theory at the end of the first 200 days, isn’t that better than screwing it up again?

We shouldn’t let Congress return to their elitist ways.  We just had an election to try to break the government from doing that, and it will take continuing public pressure to be sure they got the message.

The ideas presented above are simply suggestions.  If you have different ones, let Washington know. No one knows better than the end-users what isn’t working for them.


If you people out there agree with any of this, forward a link to this piece to your Congressman or woman or write a letter of your own. They aren’t going to reach out to you if you don’t tell them to do so. 

From → op-ed

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