Trumpcare will have the same unpleasant outcome as Obamacare because the basic flaw in both is allowing healthy citizens the option to avoid health care premium payments until they are seriously ill at which time the cost becomes enormous. The current band of Republican political elite are retracing the tortuous path that Democratic minions took to develop the current incomprehensible and failing health care system.
Young, healthy citizens will never be induced to voluntarily purchase health insurance. Ultimately, Trumpcare will become untenable, and the country will be forced to consider the obvious solution: universal health care. The trick will be to minimize government involvement — the VA exhibits all of the problems that are present in the U.K. national health system — without developing a secondary high quality parallel cash system for those who can afford it.
Blue Cross and Blue Shield worked very well in the 1960-1990 period as nationwide nonprofits with minimal government intrusion. The organizations administered Medicare in the 1960s. Return Blue Cross and Blue Shield to nonprofit status and turn over to it development, maintenance and updating of a new global health care insurance contract, as well as collection of care cost data. Alternatively establish a new permanent non-governmental organization staffed by the American Medical Association and various consumer groups to provide the above functions. Current private insurance companies would have a role analyzing cost data, collecting and investing premiums and paying medical costs — basically sub contractors to the NGO with a fee per contract serviced.
Every citizen has two absolute health care costs — at birth and at death. Everyone may also have some serious health problems between those two: heart disease, cancer, diabetes and a list of slow degenerative diseases. Unlucky individuals will contract diseases with health care costs that are extremely high but only affect a small percentage of the population.
Using historical data adjusted for inflation, it is possible to develop an average health care cost for every citizen from birth to death which can be updated yearly for new treatment methods and breakthrough solutions to diseases as well as development of orphan drugs for rare diseases. To simplify the assignment of costs, take the average of men and women of all ethnicities and develop a single yearly premium.
At birth, every child should be assigned an individual lifetime health insurance contract by a company through competitive bidding. Parents pay the premiums until the child is financially independent — whether they are 18 or 38. The majority of health care costs occur in the two to three year period before death; so on average once the costs of birth are covered the premiums will accumulate in individual citizen accounts until the end of life. Premiums will be adjusted yearly based on changing coverage in the global contract and investment results from accrued premium investments. Once a year the most successful investing insurance companies offer lower premiums and compete for every citizen's — young and old — existing contract recognizing the cash that has accrued to that point in an individual's account.
At least 25 percent of U.S. medical costs have nothing to do with health but with provider's staff required to navigate the complex byzantine health care regulations and contract details. By using a standard contract and assignment at birth to all citizens, the administrative costs will be drastically reduced; the pre-existing conditions debate will be eliminated; and by developing the basic contract by an NGO agency, we will avoid the problems associated with other nations' government run health care systems.
On a sliding scale, premiums may be subsidized based on the income of the parent and then the individual after reaching an employable age. Add a deductible of 2 percent of gross individual income — zero until an individual is employed — that will act as a subsidy from the most successful citizens to the least successful in the form of lower overall premium payments and also act as a deterrent to unfettered use of health care facilities. Individuals will not clog the system with questionable complaints if they have to pay for the service.
Medicare now works reasonably well, and premiums are charged on an individual basis. Without disrupting any of the current employer provided health care contracts, offer Medicare to everyone by slowly reducing the age for eligibility by five years every year. At the same time, with appropriate financial adjustments for age, expand the newborn contracts by five years of age every year and offer to cover older children and millennials with their understanding that every year they reject coverage, their individual premiums will increase when they eventually seek coverage. By the end of seven years, every U.S. citizen would be covered by the newly created infant policy, Medicare or a corporate sponsored policy. Ultimately Medicare and the corporate policies disappear as citizens retire and die, and in one generation newborn NGO universal health care becomes the remaining coverage. During the seven-year start-up period, cover all insurance company losses under Obamacare era exchanges to prevent loss of coverage.
As an aside there would be no individual maximums on total costs since the system by design on average covers all medical situations. All citizens may use a doctor and medical facility of their choice with the caveat that the central health NGO continually sets and updates recommended fees for service that do not discourage doctors and hospitals from accepting patients. Adopt Texas tort laws to reduce malpractice insurance costs, and apply "most favored nation" pricing principles to lower drug costs to international levels. Private insurers offer supplemental coverage on any issues not included in the global contract — i.e. current Medicare practice.
Establishing Trumpcare will be complex and continue the chaos and acrimony that accompany Obamacare with the same result. Health care cannot be reduced to optional commercial decisions. Ultimately we will have universal health care. It would be better now rather than later.
Charles Campbell (firstname.lastname@example.org) is retired senior vice president of Gulf Oil Corporation.