Health Care

We need to cause health care to cost less. There are two ways to reduce costs: (1) socializing healthcare (i.e. Medicare-for-all, etc.); or (2) increasing competition mainly by reducing the impact of the third party in the health care equation. Allen Buckley prefers the latter approach. Like college education, the third party in the health care equation causes costs to be greater than they would be with a two-party transaction.

Patent rights should be cut in half for drug manufacturers that charge more in the U.S. than they charge in other countries.  Ip WSJ article on drugs Feb 14 2020 (PDF) “Pay to delay” practices, and similar means of deferring the use of generic drugs (or indirectly extending patent life) should be illegal. These necessary law changes have not been made because the two major parties have sold out to the drug industry.

Allen Buckley is in favor of changing Medicare and tax subsidies for private care so that patients have more skin in the game, while not breaking anyone in the process. Regarding private care, tax subsidies (deductions, exclusions and tax credits) should be provided only for high deductible health plan (HDHP) care coverage and health savings accounts (HSAs). (Medicare proposed changes are provided in the Entitlements section.) The Financial Sanity Act permits tax deductions for health insurance only if it is high deductible health insurance, and further provides that the deductible may be as low as $0, as long as the co-insurance percentage of any transaction (paid by the consumer) is at least 50 percent. The Financial Sanity Act (PDF). Summary of the Financial Sanity Act (PDF). On its website, HHS should supply common means of treating different health problems, so people can analyze and then price shop. Medicaid funding should be significantly reduced for states that provide for Certificate of Need (CON) laws. Insurers and employers should be granted far more flexibility to: (a) tailor policies; (b) exclude certain preventative coverage; and (c) charge more for unhealthy behavior, including excessive sugar intake. It should be unlawful to discriminate based on pre-existing conditions not due to personal bad habits.

Roughly 1/30th of the U.S. population is covered by Obamacare individual coverage. Certain aspects of it should be kept and the rest should be repealed. The generally good aspects are: (a) universal availability of coverage (i.e., no one can be denied coverage based on health); (b) the SBC (summary of benefits and coverage that provides a simple explanation of coverage and costs); (c) the requirement that a third party (unrelated to the employer plan’s sponsor) serve as administrator of appeals of denied claims with respect to an employer health plan; (d) varied costs based on ability to pay; and (e) annual limits on out of pocket costs. The bad aspects include: (a)  extreme complexity; (b) a coverage gap with respect to lower income persons and households in many states; (c) failure to account for wealth when analyzing eligibility for premium credits and cost sharing subsidies; (d) failure to consider other entitlements and tax benefits available; (e) failure to induce people to be prudent health care consumers (thus doing little to reduce medical costs); and (f) illogic as to benefits (a family of four with income (AGI) of 399 percent of the federal poverty level (FPL) in 2019 received credits of $4,853; the same family with AGI of 400.1 percent of the FPL received $0). Tax benefits (e.g. the standard deduction) and entitlements should be reduced for people who do not maintain reasonable health coverage for themselves and their dependents. (In 2020, a constitutionality challenge to Obamacare is pending in the courts.)