President Donald Trump made ridiculous promises about health care on his way to the White House.
"Everybody's got to be covered," Trump told CBS' "60 Minutes" in 2015.
"We're going to have insurance for everybody," he told The Washington Post in a Jan. 15 interview.
He then aligned himself with a weird Republican plan to repeal and replace the Affordable Care Act with something critics call "Obamacare Lite."
The nonpartisan Congressional Budget Office reported Monday that the bill would cost 24 million Americans their health care coverage by 2026.
Colorado economist Linda Gorman of the Denver-based Independence Institute, a free market think tank, eviscerates the plan as a "sham" in an article for The Hill.
Like Obamacare and most politician-inspired proposals, the Republican plan tinkers with federal subsidies and a host of boring details regarding tax credits, cost-sharing provisions and other internal mechanisms of the insurance market.
It's all about who's going to pay for what and the hoops one must jump through to get someone else to pay a bill. The plan is all about coverage, not about care.
Though average Americans struggle with health care access, they enjoy easy and affordable access to food. That is, in part, because politicians ensure a market flooded with food. They subsidize farms and agricultural equipment. They allowed some hippie in a Texas garage to create Whole Foods, then sued him for trying monopolize the market with his acquisition of a competitor. Local, state and federal governments move mountains to constantly increase the market's supply of food and retailers to sell it.
Anyone inclined to complain about food prices should consider what groceries cost in 1913, when the federal government began tracking prices. A dozen eggs averaged 37 cents. Corrected for inflation, the same eggs should cost $9.15 today. Instead, they cost $3 or less. A pound of butter today should cost more than $10, to equal its 2013 price. Supply-side policies have improved our access to food.
When we want access to affordable energy, we encourage more energy production of all types, including wind, solar and fossil extraction. In all facets of life, the goals of enhanced access and price reduction result from boosting supplies of goods, services and commodities.
To make health care affordable and accessible, Republicans need to stop tinkering and start thinking big. They need a long game to expand the supply side of the health care market to the point physicians, clinics and hospitals compete for patients. They could start by:
- Directing the Department of Education to facilitate more young people in the pursuit of medical careers.
- Directing the Small Business Administration to incentivize and support health care startups in big-box stores and strip malls.
- Direct the Federal Trade Commission to identify all protectionist policies and other barriers to competition in the market, such as "certificates of need" that some states require before entrepreneurs can establish medical businesses.
- Bolster protections for health care providers against predatory lawsuits.
- Reconfigure immigration policies to attract the best and brightest physicians from around the world to live and work in the United States.
- Qualify and authorize nurses to issue prescriptions.
- Expand responsibilities of physician assistants and nurse practitioners.
- Distribute block grants to help rural areas recruit and retain medical professionals.
When Medicaid patients can't get appointments, they are subjects of rationing. So are wealthy and fully insured patients who must wait weeks or months to see specialists.
Long waits and high prices are signs of a seller's market. Customers are in surplus, relative to providers.
In a buyer's market - heavy on providers - hospitals, clinics and sole practitioners would compete for patients with swift appointments and competitive pricing. Insurance would take its rightful place as a contingency for unusual, catastrophic medical events.
We can't fix health care by tweaking the details of subsidies that chase soaring prices. If we want more access at lower prices, we need more providers competing for our business. There is no shortcut.
the gazette editorial board