Last night in Las Vegas, Democrat candidates for their party’s Presidential nomination gathered for a TV “debate”. The group acted professionally and Presidential. Allowing for the fact that it was a “made for TV” event, the candidates spoke of real problems facing the US, and for the most part offered real solutions. OK, maybe not solutions, but at least policies which could ameliorate or lessen the social problems.
In stark contrast, the previous GOP debates displayed one candidate after another speaking to non-issues (or at least issues way down the list in importance) and pandering to subjects dear to extreme elements on the conservative right. Much of the media has pointed to Donald Trump as the instigator of most of the Republican inflammatory rhetoric but under inspection, none of the GOP candidates seems to have a handle on the big issues facing the Country and proposing policies which have a chance of being implemented. To be fair, the GOP candidates all endorsed a wall with Mexico but differed on how high and how long it might be. Hmmm.
Not waiting for the next GOP debate, Jeb Bush shared his healthcare plan yesterday. Not surprisingly the plan solves problems that do not exist, leaves deficiencies unaddressed, and opens more questions on how Bush’s proposals would be financed. in practical terms, unanswered financing questions is a place holder for subsequent service cuts that “we can not afford”.
Bush’s professorial speech was pretty much what one would expect for a plan which begins with “repeal Obamacare and start over”. Healthcare is complicated stuff and unless one is clear about key assumptions, (which were absent in Bush’s speech) the policy house of cards built upon these assumptions will possess glaring holes.
Bush’s plan, while dressed up to appear new, is a rehash of previous GOP “repeal and replace” proposals.
- Medicaid would be capped and replaced with block grants to States who intern would cater to as many of the poor as that State felt appropriate. Read this proposal as “under Bush, the US will reduce coverage to those who can’t afford healthcare insurance and reduce the number covered.
- For those purchasing insurance or receiving it from employers, Bush would eliminate any requirements for “basic” coverage which would allow individuals to buy bargain priced policies with poor coverage limits and employers the opportunity to offer as little coverage as they can get away with.
- Bush would also eliminate individual and employer mandates. This would allow both individuals and employers to game the system by not participating in insurance pools until an individual needs coverage (like becoming ill or injured). Bush claims his plan would reduce healthcare costs but neither cites how much would be saved or how key elements of his plan would be paid for.
Jeb Bush also avoided mentioning key assumptions and obvious contradictions.
- Why for example should one person receive better healthcare coverage than someone else? The age old GOP answer is because they can afford better coverage. Hmmm.
- Bush was silent on why it is ethical for a poor person in New York to receive different healthcare (either more or less) than a similarly poor person living in Iowa or Texas.
- Bush also did not address what safety net would exist for individuals who did not receive healthcare from employment and could not afford “basic” coverage policies. With Bush’s proposed tax credits, in theory, individuals could obtain stripped down coverage.
Obamacare, which is simply a tweak of what came before it, is based upon the two assumptions. (1) Healthcare is not free and must be paid for. And, (2) basic healthcare is a right for everyone. Never the less Obamacare still many weaknesses.
Overall cost is probably the most obvious one. Individuals and employers feel the brunt of the highest healthcare costs in the world (two times other modern countries). This straps the average consumer with a hit to their disposable income, and walks employers with higher costs of doing business.
Universal healthcare plans similar to those in Japan, Canada, and Europe could reduce the cost of equivalent or better healthcare by one half (50%). There are no free lunches so this cost reduction must come from less money flowing to hospitals (and their staffs), doctors, and drug/medical device companies. Improved efficiencies could mitigate some of the impact upon compensation for these healthcare providers (providing more service for the same amount). Unfortunately, mathematically there would still need to be significant compensation reductions in order to achieve world class standards.
Jeb Bush tried to claim cost savings but his only savings were tied to reduced healthcare availability. Shameful.
Capturing world class healthcare cost savings opportunities will need a comprehensive plan and be phased in over time (to avoid open revolt with healthcare providers). Dancing around the edges, as Jeb Bush has done, will become very transparent if he should try to build his campaign around this issue.
Maybe for now, it is simply to gain GOP primary voters’ attention (at any cost).