Healthcare Policy in The Post Truth Era
Stanley Feld M.D.,FACP, MACE
The government has been deficient in trying to do anything to Repair the Healthcare System.
Unfortunately, John McCain’s vote blocked the repeal of Obamacare which froze any progress. His reason was feeble and politically naïve.
John McCain wanted congress to work together and have bipartisan agreement on healthcare reform. The entire majority of the present House of Representatives has no desire to be bipartisan or help President Trump create or pass any bipartisan legislation.
Democrats in the house only want to impeach the president. They have no time for positive legislation to repair the healthcare system.
I believe the Trump administration has the right idea.
President Trump and his administration have decided to make structural changes to the healthcare system by executive order until it can make big legislative changes. Their hope is they win a more cooperative Congress in 2020.
We are living in a Post-Truth era.
“Post-truthpolitics(also called post-factual politicsand post-reality politics)is a political culturein which debate is framed largely by appeals to emotion disconnected from the details of policy, and by the repeated assertion of talking pointsto which factual rebuttals are ignored.
Post-truthdiffers from traditional contesting and falsifyingof facts by relegating facts and expert opinions to be of secondary importance relative to appeal to emotion. While this has been described as a contemporary problem, some observers have described it as a long-standing part of political life that was less notable before the advent of the Internetand related social changes.”
The media is the message. Donald Trump threatens the Democratic Party, the bureaucracy and the traditional mainstream media. He also threatens some of the Republicans.
He is a crude speaking person from Queens, New York. He has been called a brawler by some. He says he never starts a fight. He fights back. Many say he fights back in an unappealing way.
He says his goal is to drain the swamp. We have all gotten a glimpse of the inefficient and at times corrupt bureaucracy within our government. We can see the swamp’s depth only because of the Internet and the availability of alternate news opinions.
President Trump is working hard to streamline and increase the efficiency of the ever-expanding bureaucracy. He is a direct threat to their well-being. This is their justification for hating him.
The traditional mainstream media has promoted the Democrats’ agenda. They have helped obstruct President Trump’s agenda. The media has ignored or criticized the continual successes of President Trump.
It has either published disinformation or misinformation, ignored critical thinking on issues, or simply published non-truths.
President Trump has had no choice. Obamacare remained the law. It has been expensive and unsuccessful. It is impossible to know its yearly cost to the federal government. It is self-imploding and will disappear shortly.
Obamacare has just completed its open enrollment period for 2020. The enrollment period is supposed to end on December 15th. The Obama administration extended it to March 31 during some enrollment years. The Trump administration has extended the 2020 open enrollment period until December 31, 2019 this year.
85% of people who enrolled in Obamacare have a preexisting illness. The Obama administration has subsidized most of the premiums. It did not subsidize the deductibles. Obamacare participants still could not afford to pay the deductible. In essence, participants have no healthcare insurance because they could not afford to use it.
Open enrollment as of December 7, 2019, was awful.
There are only 6,134,477 who have enrolled in 2020 compared to 16.1 million enrollees in 2014. Medicaid was expanded by 9.3 million in 2014. With the Medicaid expansion, a total of 25 million people received insurance in 2014.
Medicaid is a single party payor. It is inefficient. It has a problem getting physicians to participate because reimbursement does not cover most physician’s overhead.
President Obama decided to have the federal government pay over 90% of the state-run Medicaid programs for a few years. The states, which signed up for the Medicaid expansion, did not have an increase in costs.
When states have to start paying more for the Medicaid expansion, they will have to raise taxes because by law they cannot have a budget deficit. At the moment most of those states have unauthorized budget deficits. Those deficits will become worse when they have to fund expanded Medicaid.
The mainstream media and Democratic congress continually publish the figure that Obamacare has decreased the uninsured by 20 million. However, eleven million were that result of the expanded Medicaid program.
The numbers do not match. The government graphs are complex and confusing. However, they are very informative. The graphs tend to confuse us with estimates and actual enrollees.
In 2016 the numbers decreased to 9.3 million with open enrollment extended to February 1, 2016
Medicaid enrollment increased in 2016 to 15.3 million. The Medicaid increase is included in the total number of previously uninsured, Obamacare provided healthcare insurance. Obamacare’s increase in previously uninsured is, in fact, an expansion of Medicaid. The mainstream media use the number 20 million newly insured patients which is a misleading justification for fixing Obamacare. Some of Medicaid’s increase enrollment could represent the illegal immigrants who are now entitled to healthcare coverage.
The net Medicaid increase since March 2010 in 2016 was 16.3 million. It looks like Obamacare’s goal was to increase Medicaid. The next step is to have “Medicaid/Medicare for All.”
2018 remained the same as in 2016, with many more dropouts because people realized Obamacare’s unaffordability. Since it was unaffordable, they realized they could not afford care event thought they paid their premium. Therefore, they dropped out and stopped paying their premiums.
2020 has been the expected disaster. Consumers needed relief from the Obamacare disaster. Obamacare has caused a further increase in dysfunction in an already dysfunctional healthcare system for people insured by Medicare, Medicaid and Private Healthcare insurance.
Everyone is dissatisfied.
Only 6.1 million consumers have enrolled in Obamacare for 2020.
President Trump is hoping that after the 2020 election, he will have a friendlier Congress. Obamacare will be repealed. Congress will want to do something to help him repair the healthcare system. Meanwhile, he can only do some structural changes to lead us on the path toward an affordable healthcare system.
I predicted Obamacare would eventually fail when it was passed in 2010. Obamacare did not align stakeholders’ incentives!
Obamacare was destined to become unaffordable to consumers, the states and the federal government.
Bernie Sanders’ and Elizabeth Warren’s “Medicare for All” will suffer the same fate as Obamacare.
Most of all the taxpayers in the nation will suffer the most.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
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