Tuesday, January 17, 2017

Medicare For All?

President elect Trump has stated that his plan to replace Obamacare would allow everybody access to health insurance. While the Republican Congress struggles to decide what to replace the PPACA with, perhaps Trumpcare would be another version of the old public option, a Medicare for all.

It doesn't sound as preposterous as it seems. What are some of the advantages of allowing universal access to Medicare? First of all, it would have almost immediate bipartisan Congressional support. Universal Medicare was championed by Bernie Sanders during the primaries. Much wasted bloviating on both sides of the aisle would be eliminated by implementing universal Medicare instead of arguing about tax credits and and pandering to the wealthy.

Medicare is also widely accepted throughout the country. Virtually every hospital and physician already accepts Medicare. There would be far less concern about narrow hospital and physician networks. You can just go to your old doctor and the plan will be accepted. The claim that you can keep your doctor if you like your doctor will finally be true.

Universal Medicare is portable. Change jobs? Keep your Medicare. Move across state lines? Same Medicare in all fifty states. Universal Medicare would also drive competition in the health insurance market. Already hundreds of counties have only one choice for health insurance. Universal Medicare would give these companies more competition to lower prices and allow people to buy insurance if the private companies don't offer any plans. In essence, the entire country becomes one giant risk pool for health insurance, which was one of the goals of Obamacare.

Don't forget people actually like Medicare. It's one of the untouchable pillars of the federal government. It would have immediate mass appeal. Intuitively it makes sense to most people. This is what people think of when they talk about universal health insurance in other industrialized countries. Its appeal would make the legislation much easier to pass.

How to pay for it? People will buy into it just like they purchase any other health insurance plans. Unlike regular Medicare, people will buy the insurance, with the premiums based on income. The more money you make, the more you pay for Medicare plans.

Business deductions for health insurance could also be eliminated to help pay for universal Medicare. Right now this sweetheart deal brokered in the early 20th century gives unfair advantage and income to people who work for companies that offer health insurance. Small business owners, private contractors, part time workers, and millions of others don't get this deal. Removing health insurance deductions for businesses would free up billions of dollars and remove price distortions in the health insurance markets.

So could Trumpcare be a form of Medicare for all? It's hard to fathom what goes on under his orange hair every day but who knows? He is not beholden to either political party and can put forward his own plans without worrying about appeasing the right or the left. He just might do something this bold and Big League.

Monday, January 16, 2017

Meet Tom Price

If you have any questions about who is going to lead the medical care of this country for the next several years, the New York Times has a lengthy article about Dr. Tom Price, the nominee for the next secretary of health and human services. It recounts his ascent from a community orthopedic surgeon to majority leader of the Georgia Legislature and now potential boss of the largest expenditures in the federal budget.

In a one sentence blurb, the article briefly mentions that Mr. Price has a plan to replace Obamacare with something better and more substantive. While the mainstream press may keep harping on the Republicans' lack of a real plan to get rid of the PPACA, Mr. Price has already published very long and specific ideas he introduced as the Empowering Patients First Act. So next time you hear some uneducated colleague moan about Republican grandstanding, you can just point to Mr. Price's website and show them that there are plans in place if one cares enough to make an effort.

Thursday, January 12, 2017

RIP Obamacare

The Senate early this morning has started the long process of repealing the flawed PPACA. In a party line vote, they elected 51-48 to begin dismantling this monstrosity and start exploring better alternatives.

The Democrats are vociferously defending their beloved former president's plan despite all the evidence that it is failing and needs a major overhaul anyway. Insurance premiums are skyrocketing again. More doctors are getting excluded from the insurance companies' ever tighter networks. Hundreds of counties in the country have only one insurance company to choose from, if they can afford it. Millions of people are still forgoing insurance coverage despite tax penalties and favorable coverage.

Hopefully any new plan created will truly allow you to keep your plan and your doctor if you really want it. Wouldn't that be a refreshing change? RIP Obamacare 2010-2017. You won't be forgotten and you definitely won't be missed.

Thursday, January 5, 2017

Best Paying Job In America Is...

CNN and PayScale.com is out this morning with their list of the best paying jobs in America. Ranking right at the top of the list for the highest compensation in the country is anesthesiology. We earn a median income of $335,000 per year. PayScale says top anesthesiologists earn can $466,000. And I know a lot of anesthesiologists who make much more than that. Right behind anesthesiologists are radiologists. They earned a median salary of $316,000 with top pay of $492,000. They are followed by physicians (general), petroleum engineers, and dentists.

It's interesting that this list differs from Medscape's annual list of physician compensation which routinely ranks orthopedics as the top paying medical profession. Anesthesiologists usually land in the top ten of all physicians but never number one.

However, just because we have the highest paying profession in the nation doesn't mean we have the best job. PayScale has a different list for that. Instead of highest income, if you count work satisfaction, highest job growth, and relatively good money, phone app developers have the best job, with a median pay of $97,100. Goes to prove that money can't buy happiness and you shouldn't go into medicine just for the income.

Monday, January 2, 2017

Liberals Are Out Of Touch

The Republican Congress is set to start repealing Obamacare this week when it convenes in Washington. As the New York Times reported, the Democrats are throwing up road blocks every chance they get go keep it from happening. House Democratic Leader Nancy Pelosi describes the virtues of the law as "successful in meetings its goals of reducing cost, increasing access and improving quality of care."

Oh talk about fake news. What does this multimillionaire from the San Francisco know about how the PPACA is actually working? Reducing costs? Show me one shred of evidence that medical costs are going down anywhere. After the law went into effect, costs did not increase as much as previously projected, but they went up nonetheless. Even that was a temporary event since expenses are now expected to rise at a much faster rate than the last few years.

Maybe she meant that insurance costs went down for people who bought health insurance through the exchanges. That would only be true if you leave out the huge government subsidies that allowed people to buy their insurance for a couple of hundred dollars per month. Millions of others receive zero subsidies. They are paying every cent that the insurance companies are charging. And this year they increased the premiums by double digits to cover their large losses working within the law. So I don't agree that taking more of my tax dollars to pay for somebody else's insurance should be construed as lower costs. It's just passing the buck.

Obamacare has famously brought less medical access to patients than before. Remember the infamous promise the president made before the law passed? You can keep your doctor if you want? That was a complete lie. Now we have plans with the tiniest networks that the insurance companies can assemble to keep their own costs down. Many doctors also refuse to take patients with Obamacare insurance. This leads to patients have more access to insurance but they have less access to actual medical care.

As far as stating that Obamacare has improved the quality of care, again where's the beef? If it was so easy to improve medical care with a simple wealth redistribution law, why didn't we do it earlier? Yet we are always being negatively compared to the wonderful European systems where people routinely live to 90, have BMI's of 21, and have zero birth defects. Please show me any evidence that Obamacare has improved medical quality. And having every doctor spend thousands of dollars to move their patients' charts to computerized systems doesn't count.

Therefore the Democrat's desperate attempts to maintain Obamacare as their soon to be former president's legacy is based on nothing but lies. These Congressmen and their families don't purchase health insurance through the PPACA. They all get subsidized government health insurance that are not available to the general public. Let Nancy Pelosi and Chuck Schumer buy their insurance through the law they famously passed without reading first and see how they would like it.