The TRUTH about Obama / Trump Care (Part Three - Conclusion)

In Part 1 of this blog, I described the parts of Obamacare that ARE working.  

View Part One Here: https://scottmcmurrain.blogspot.com/2017/03/the-truth-about-obamatrump-care.html

In Part 2 of this blog, I outlined where Obamacare falls short and is in desperate need of repair.

View Part Two Here: https://scottmcmurrain.blogspot.com/2017/04/the-truth-about-obama-trump-care-part.html

In Part 3 of this blog, I recommend SOLUTIONS.  Anybody can complain about what is wrong with the system, but any solution needs to start with some fresh IDEAS, and here are mine.

NOW, PART THREE

Both of above parts were researched, and were factual, unbiased reports.

In this final part, however, I am offering my OPINION on how this system could be fixed.  I am not naive enough to believe a system this simple would solve all of the problems, nor I am naive enough to believe any of our current politicians have the will power to even suggest such a system.  But I am offering my ideas as a starting point for a discussion, with the hope that the will make sense to enough readers that maybe, just maybe, some real solutions could be reached.

SIMPLIFICATION

Right now, we have way too many different health care systems in place. Each state has its own Medicaid program. Elderly people are covered under Medicare. The military has its own network. Veterans have a complete ecosystem of their own. The CHIP program insures children at risk. Employers buy group insurance for their employees. Obamacare regulates individual policies and is intertwined with all of the other systems as well.

I propose we eliminate ALL of them and replace it with the system such as outlined below. This would greatly reduce government bureaucracy. It would vastly simplify the entire system.

Every American citizen would be automatically covered. This will eliminate the entire bureaucracy that currently is needed to determine individual eligibility for millions of Americans. That alone will save billions of dollars!

LEVELING THE PLAYING FIELD

The first thing we need to do is fix the pricing and billing systems used by the medical industry. I propose that every provider must maintain a price list for its services, and everyone must be charged the prices that are on the list. However, providers would be allowed to provide any service to anyone without charge at any time. They would also be allowed to discount their prices for no more than 15% of their customers in any given year. This would allow them to service those who truly could not afford to pay while still requiring them to stick to standard prices for everybody else. If they were allowed to discount to everybody, the standard prices would become meaningless.

I believe in the free market, and want to keep it intact as much as possible in the health care industry. Where there is adequate competition, the providers should be free to set their own rates. This would include almost every doctor and small practitioner. Where they is no adequate competition, prices should be regulated to be equivalent to other jurisdictions where adequate competition exists, taking any local variances into consideration.

Since the medical providers must make their prices standard and transparent, market forces will prevent them from overcharging, but would still allow more talented and experienced providers to charge more than younger, less experienced ones.

Next, we need to get rid of the system where everybody and their grandfather sends you a bill whenever you go to the doctor. That’s ridiculous. No other industry does this. When you take your car in for repair, you pay the repair shop and driver your car home. You don’t get a separate bill later from the transmission shop, the radiator shop, or any other company you have never heard of.

If a doctor orders a lab test, then the lab must bill the doctor. The doctor may then add this charge to your bill without markup, providing he has quoted you a price and obtained your authorization prior to ordering the lab work.  (This requirement would be waived in emergencies where prior obtaining prior consent is not practicable.)  The labs, like all other providers, can set their own prices, but must publish this price list and charge all customers the same price. If a doctor owns 5% or more of the lab, he either must give the patient the option (and prices) of an additional lab so that the customer may choose, or he can charge the patient the average price for such lab work as determined by the government. Lab tests that are performed outside the doctor's office, prescription drugs, and equipment costs would still be paid directly by the patient.

Last, but not least, are drug companies and medical equipment providers. They present a different issue, since many of them have no competition, especially when they are marketing a new drug they developed. Once again, I want the free market to prevail as much as possible. So I would allow them to set their own prices, but still require them to charge U.S. customers no more than the average price they charge customers anywhere else in the world. In addition, U.S. Customers would no longer be prohibited from purchasing drugs from outside the U.S.A. if they can get a better price.

PAYING FOR IT

To prevent abuse, all patients need to have some skin in the game. They need to be responsible for their own expenses within the limits of their income.

I would propose a single payer system that would work as follows:

(1) The Federal Government would establish base prices for each type of service based on the average prices charged in each area. The Federal Government will pay for 80% of this price, or 80% of the actual cost, whichever is less. If a provider chooses to charge more than the “standard” price, then the patient will be responsible for that part of the bill in addition to the 20%. This will provide incentives for doctors to keep their prices down, but will allow those in demand to charge more for their services. The Free Market will return.  This includes costs for drugs, external lab tests, equipment, and transportation charges.

(2) Each person, or family, will have a maximum out-of-pocket expense not to exceed 10% of their income each year. Once that is reached, the Government will pay all costs, including any excess charges over the standard should they choose a more expensive provider, which could easily happen when a top-notch surgeon is needed for an extreme case. A medical disaster should not be a cause of bankruptcy!

(3) People will no longer have separate health-insurance premiums. Health-care costs will come out of the General Fund. Of course, Federal Income Tax rates will have to be increased to cover the costs, and it will be up to Congress to set the rates and the brackets.  But without the health insurance premiums to pay, the average taxpayer should SAVE money even after the income tax increase.

It is important to realize that this is a single PAYER system, NOT a single PROVIDER system. The doctors, hospitals, drug companies, and equipment suppliers will be independent businesses just as they are now. They will NOT work for the government, and are free to run their businesses WITHOUT GOVERNMENT CONTROL, just as they do now, except for the new pricing polices described above.

COVERED SERVICES

All medically necessary services will be covered, including dental and vision services, and pre-existing conditions do not matter. Elective procedures, including abortions, would NOT be covered. Contraceptives would be covered. ONLY U.S. citizens would be covered, except for Emergency Services. Legal immigrants who have a job here and pay taxes would also be covered.

THE TOTAL COST

Of course, the CBO has not scored my plan, either.  So we don't know the total costs of the program. But since this program addresses the COSTS of the actual services rather than who pays for them, the total cost for health care in the U.S. should go DOWN under this system, especially when you consider than insurance companies will no longer be taking up to 20% of the costs right off the top.

Trump's termination of Comey

Two nights ago I wrote about Trump’s firing of Comey and the horribly partisan reporting done by CNN and FOX.

I took the position that Trump was right to fire Comey based on the letter from Rosenstein; a letter that was timely considering that Rosenstein had just taken office.  I particularly criticized CNN for downplaying this logical explanation and appearing to be biased.  On Fox, Hanity’s show correctly pointed out the proper timing of the letter and its importance, but lied or misstated facts about almost everything else.  Fox did not even pretend to be non-biased.

But, since then, additional facts have become public which are casting the firing in a different light.

I agree Comey should have been fired.  He should have been fired back in July.  He really should have been fired back in October, when his actions clearly effected the political process.

But it’s the TIMING AND MANNER of his firing by Trump that clouds the issue today.

Trump had ample opportunity to fire Comey; he could have done it at any time after taking office.  Instead, he publicly praised Comey and even blew him a kiss:  hardly the actions of someone considering firing him.  While Rosenstein’s letter was timely, and appears to be a legitimate reason behind the firing, it’s significance fades when contrasted with other facts that have recently emerged.

It appears that in recent days, Comey has been ratcheting up the FBI’s investigation into possible collusion between Russia and Trump’s campaign. Specifically, in the past couple of weeks, Comey asked the Justice Department for additional resources and funds for this investigation.  A Grand Jury has issued subpoenas to several members of Trump’s campaign asking for business records that could shed light on any possible collusion. Comey himself confirmed for the first time, in testimony between Congress, that an official investigation into Russia and the Trump Campaign has been ongoing since July.

Aside from the undisputed facts above, several additional circumstantial factors cast even more doubt as to the real reason behind Comey’s firing:

Trump’s letter to Comey failed to mention anything about the reason for his termination.  Instead, one third of the letter was dedicated to making a point that Comey had told Trump on three occasions that Trump was not under investigation.  Any reasonable termination letter, especially one that is issued out of the blue, should list the reason or reasons for the termination.  This letter did not.  Instead, it made a point that Comey was NOT being fired for his investigation into Trump.  It is clear to any outsider looking in that foremost on Trump’s mind was that investigation, not Comey’s improper actions almost a year ago.  As any cop will tell you, when someone, almost randomly, goes out of their way to point out their innocence, that is a huge red flag.

It is true that Comey made another major blunder last week when he gave inaccurate testimony before Congress.  That could have served as a catalyst, or even the final straw, for his dismissal this week.  But the Trump’s letter did not mention this, nor did the White House even mention this as a reason for his dismissal.

When Trump was presented with evidence that Flynn had lied from the Attorney General, he took no action at all for 18 days.  Yet, are we to believe that he took action against Comey within hours of receiving an unsolicited letter from his newly appointed Deputy Attorney General? There have been unsubstantiated reports that Trump, Sessions, and Rosenstein had conferred by telephone the day before and that the letter was written in an attempt to justify the timing of the firing. The White House has disputed this, so it may or may not be true. But it fits the pattern.

I re-read Rosenstein’s letter.  It is not actually a letter to Trump recommending that Comey be fired. It is actually a memo to Sessions outlining Comey’s transgressions and contains Rosenstein’s opinions.  He does not actually recommend firing Comey, but it is implied quite obviously.  But he also points out that replacing an FBI Director is not something that should not be taken lightly.

But, according to the White House’s own explanation, this is exactly what Donald Trump did.  Upon receipt of the letter, he immediately decided to fire Comey.  Aside from Sessions and Rosenstein, he consulted no one else. He did not consult with anybody in the legislature, not even members of his own party.  His own staff was left completely unaware.

Then there is the manner in which Comey was fired,  Comey was not called to the White House to be fired.  Instead, an aide was sent to deliver a letter to the FBI while Comey was in LA speaking to potential new recruits.  He found out about it during the middle of his speech when he saw it on the news.  To fire someone in this matter is something you do when there is a critical, time-sensitive need to remove him, such as if he were about to take an action that could compromise national security or something similar.  But, if his firing really was related to something that happened more than 6 months ago, the proper thing to do would have been to wait until he returned, and informed him of his dismissal BEFORE sending out a press release.

Trump is famous for rewarding loyalty and punishing those who are disloyal. Comey’s actions during the election undoubtedly HELPED Trump, and arguably cost Hillary the election. After the election, Trump had nothing but praise for Comey.  Trump’s cabinet appointments have consisted solely of loyal supporters, regardless of their qualifications.  On the other hand, the only times Trump seems to act without delay is when he feels someone is being disloyal.  When Yates refused to enforce his order, she was immediately terminated.   The sudden termination of Comey after all this time does not fit Trump’s pattern unless he felt that Comey was not being loyal. Comey’s actions before the election and his testimony last week solidified Trump’s position and hurt Clinton’s, so there is no way Trump could have considered those acts as disloyal.  But, Comey’s recent actions to increase the aggressiveness and size of the Russia investigation despite Trump’s repeated tweets about the entire Russia affair being “Fake News” could easily be interpreted as acts of disloyalty to Trump. That would make Trump angry, and the sudden, unannounced termination of Comey in this manner would be consistent with the actions of an angry, impulsive man; especially when you consider there was no other reason for the urgency of the firing.

The White House’s response to the firing was also inappropriate.  Their story has changed repeatedly as more and more facts have come out.

Trump’s main defense has been to attack the Democrats as hypocrites for wanting Comey fired last year but protesting it today.  But what is important to realize is that NONE OF THE DEMOCRATS ARE DEFENDING COMEY.  None of them have said he should not be fired. Instead, it is the TIMING OF THE FIRING that has raised concerns.   Firing Comey WAS THE PROPER ACTION.  But, as we all know, it is possible, and common, for people to do the right things for the wrong reasons.  The Democrats are not upset that Comey is gone; they are upset at the circumstances and motivations leading up to his termination.  There are even Republicans who share these same concerns.

Calls have been made for the appointment of a Special Prosecutor to head up an independent investigation.   THIS NEEDS TO HAPPEN NOW.  This will take politics out of the equation and allow the American People to learn the truth.  And it’s entirely possible that the truth will reveal no collusion between the Russians and the Trump campaign.  Appointing a Special Prosecutor is not unpresented nor uncommon.  Since 1978, there have been around TWENTY special prosecutors appointed during the administrations of Jimmy Carter, Ronald Reagan, George H.W. Bush, Bill Clinton, and George W. Bush.  These special prosecutors are important to our democracy, as they ensure transparency and prevent partisan politics from interfering with the search for the truth.  If a special prosecutor was used to determine if Bill Clinton had received oral sex from an intern, how could anybody in their right mind not realize that the current situation clearly calls for such a prosecutor?

But the White House has taken the position that a Special Prosecutor is not needed, giving the excuse that such a prosecutor would impede the current investigations taking place.  That excuse is even more ludicrous when you consider it was given by the same people who just fired the person leading the current investigation for something that happened six months ago.  Comey’s termination is much more of an impediment to the investigation than an independent special prosecutor could ever be.

This fails the smell test, pure and simple.   We need a special prosecutor assigned IMMEDIATELY before the stink spreads outside Washington and clouds our entire Democracy.