Healthcare under Trump 

Healthcare’s Bipartisan Dilemma” in today’s US print edition of the Wall Street Journal  details several ideas and alternatives being discussed that might replace the ACA. Every example considers tweaks to the current system that abuses the market based approach. As with the ACA, the costs to cover sick folks is mashed together with the larger population of healthy people. The result, as with the ACA, is massive price and market distortion. In fact the very essence of risk (with respect to insurance and premium) is undermined. As such the free market is a monster.

There is a different way that should be considered yet it is not (yet) in the news. Literally, return the market to where it was: remove the entire ACA and permit risk to be priced into he market as it was.  

For those that fail to get insurance, offer a subsidized state-health insurance. This is the equivalent of the UK’s National Health Service but at a state level. Federal funds and state taxes would be used to pay for the service. This idea was floated in the run up to the ACA being signed and this represents a simple subsidized pool. It would be transparent and visible. The costs of this aspect of healthcare would be clear.

Finally another issue in healthcare needs to be addressed at the same time: costs. Additional efforts need to be enhanced to shift the reward system for healthcare, public (Medicare, Medicaid etc) and private. Rewards need to be explicit and focused on health, not piece-rate and work. Visits to the doctor and specialist are not relevant; results are. This program needs to be led by business people in Washington, not politicians.

Along with this is a revamp of regulations to help reduce the risk of insurance against negligence. This part of the industry puts too much of a burden on costs and needs to reduced.   

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