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article imageOp-Ed: Trump unveils flawed healthcare reform plan

By Edgar Wilson     Mar 3, 2016 in Politics
Republican presidential contender Donald Trump has finally unveiled a detailed policy platform for reforming healthcare in the United States.
His campaign has been notoriously short on policy particulars from the beginning, so the seven-point outline of legislative directives recently published on Trump’s campaign website is a significant move. Although the set of directives offers enough detail to distinguish Trump’s vision for American healthcare from his rivals’ — and, most vociferously, from the current laws implemented by president Obama — it still manages to remain vague on just how its ambitious vision would be executed.
The first point draws obvious and direct contrast with Obama’s Affordable Care Act (ACA) by targeting the individual mandate: “No person should be required to buy insurance unless he or she wants to.”
This is also a major point of departure from Marco Rubio’s proposed alternative to the ACA, which calls for the introduction of a tax credit to offset the cost of individual insurance plans; this effectively replicates the current individual mandate, which taxes those who opt not to purchase health insurance. As other analysts have pointed out, withholding a tax credit is not so different from implementing a tax penalty: they both aim to compel individuals to buy health insurance.
But where Trump’s suggestions become more ambitious, they also betray a profound, yet common failure to grasp the complexity of the structure of America’s healthcare and insurance system, relying on the popular stand-by that free market solutions will succeed where government programs fail.
The Trump Plan’s second edict calls for modification of “existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state.”
In terms of breaking down state barriers to purchasing insurance, this isn’t really an area where federal law is the impediment — if anything, it is the fact that disparate state laws create barriers to out-of-state providers easily (and affordably) complying with the myriad minutia of state-specific regulations. The ACA already created provisions to enable state to facilitate more interstate coverage opportunities; insurers and state legislatures alike have been slow to take advantage due to the sheer complexity of harmonizing their respective regulations.
If Trump’s approach were to truly nationalize insurance markets, that would require federal law nullifying individual state regulations and setting new, universal standards, something neither practical nor likely to gain Republican support, given the party’s stated preference for states’ rights and a small federal footprint.
Where Trump’s plan really falters — though it is hardly alone in misunderstanding America’s healthcare market — is point number five: “Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.”
This is a popular argument, and central to many advocates who assert that the free market could bring down prices and realize significant savings on healthcare spending nationally.
But the relationship between American health insurance, federal healthcare programs (Medicaid and Medicare), and healthcare providers simply does not fit into the free market model that governs prices and services in virtually every other industry.
The nature of healthcare within an urban environment is very different from a rural community.
The urban clinic is more likely a member of a larger provider network, offering savings due to economies of scale, as well as a wider pool of specialists, and the resources that come from association with a major research hospital and university. Community health centers, which typically serve impoverished, isolated, or otherwise underserved populations simply don’t have the ability to match their urban counterparts, which means the community health centers that serve them often utilize Family Nurse Practitioners (FNPs) rather than more expensive physicians.
Nurse Practitioners aren’t so much threatening to displace physicians as they are making up a significant access gap; underserved and previously uninsured populations are raising demand for health services, and physicians simply cannot keep up. Reducing these differences to a price chart does nothing to make up the barriers to access that drive demand for each type of practitioner.
Then there is the logistical impossibility of actually creating price transparency.
Both types of providers are already being severely disrupted and taxed by the current (and overdue) shift to digital records. This has proven neither straightforward, nor immediately cost-effective. It will take time (and many iterations, upgrades, and refinements) to fully realize the savings that EHRs may provide.
For price transparency to be enabled at the provider level, these nascent EHR systems would need to be up and running seamlessly, in order to connect healthcare products and services with each individual patient’s insurance, deductible, payment history, and network structure in real-time. The scale of data breaches and other violations of security and privacy by hackers (and neglectful users) shows just how far the healthcare sector has to go to realize basic protections and infrastructure for its new EHR systems.
Integrating the kind of high-speed accessibility and accuracy these systems would require to allow consumers to shop around the way they do on Amazon or any other online marketplace requires much more than another burdensome legislative act.
Price transparency is also unlikely to be the best use of this new health data infrastructure. There is a bounty of cutting edge medical technology that stands to benefit and emerge from this shift, and all manner of new research and treatment methods that hinge on sophisticated integration of digital platforms with health data collection and storage.
Undeniably this is the future of healthcare, enabling patient-focused medicine to exist alongside big data-supported population health management. Better treatment, as well as more comprehensive preventative interventions, together will save money at a far greater rate than simply having patients shop around like consumers.
Trump’s new platform may be a big step for his campaign, but it offers no viable solutions to the core problems afflicting America’s health sector.
This opinion article was written by an independent writer. The opinions and views expressed herein are those of the author and are not necessarily intended to reflect those of
More about Healthcare, Obamacare, Donald trump, Health insurance, Public policy
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