We should remember that despite myths to the contrary, we have the best healthcare in the world. The system, like most things, should be left alone, for market forces to govern. Healthcare per se is not the issue. Of course it could be better. It could be more efficient and more patient-centered. It is the way we pay for healthcare that drives up costs and takes control out of the hands of patients.
What we call “health insurance” today is not insurance at all. Insurance is for risk mitigation: low risk, high severity occurrences such as fire. Today, health insurance is really just third party payment for healthcare services. “Someone else” is paying the bill, and they end up with higher costs, less choice and more regulation. The current environment is choked by regulations.
On the other hand, the biggest current problem in health care coverage is individual coverage. The Affordable Care Act is failing because younger, healthier individuals are not participating, causing the sky-rocketing increases in premiums and tightening of the market. Individuals have no incentive to purchase insurance as they perceive lifetime insurability and if that fails, the expectation that society will cover their costs as health care has been perceived as a “right.” It is also problematic that employers and their employees have a tax benefit that those purchasing individual products do not enjoy.
The members of the Federalist Coalition do not believe that health care is a right but do believe that we must have solutions to provide health care to as many citizens as possible while maximizing personal accountability and minimizing government involvement. Furthermore, we believe that such government should ultimately come from the individual states as set forth by the tenth amendment.
- The Affordable Care Act (Obamacare) should be repealed and replaced by a model that is consumer driven.
- Policies should emphasize consumer driven policies – individual health insurance with high deductibles, possibly coupled with a health savings account or similar vehicle. Federal tax law would provide equivalent treatment for policies purchased by individuals and by employers.
- All individual should have the right – one time – to obtain a policy that covers preexisting conditions. Once obtained, no insurer may refuse to insure that individual. If an individual fails to maintain insurance, they should not expect to be able to buy low-cost insurance just when they need it. That drives up the cost of those who have responsibly maintained their insurance, and is a key problem with the Affordable Care Act.
- Current Medicaid funding should be provided to the state with block grants, and states should be given maximum flexibility in how they are administered. The eventual goal should be for each state to fund its own care for those who are disabled or perhaps privatize or eliminate Medicaid in favor of subsidized insurance. Whatever path each state choses, plans for those who cannot pay for their own insurance should emphasize effectiveness, efficiency, cost containment and recipient accountability. For example, preventative health care should be covered, cosmetic surgery should not be covered.
- Able-bodied low income individuals should be provided with time-limited subsidies to purchase their own insurance until they can pay for their own premiums.
- Federal laws regulating self-funded plans should be repealed with control given back to the states. Multi-state employers should, however, only have to follow the laws in their primary state, not multiple states.
- Allowing consumers to purchase insurance across state lines may increase competition, but insurers should not be forced to follow state laws of every state in which they do business, this will certainly drive up costs. They should be allowed to follow laws of their primary state.
- States should enforce existing state antitrust laws to encourage competition.
Taking the government and employers out of the business of providing, and thus controlling, healthcare payment, would allow consumers/patients to be in the driver’s seat. Providers should compete for patients based on quality and cost and there should be total transparency in both. This is a free market solution that would drive down costs and break the crony capitalist relationship between big employers, big insurance and big government. It is a lofty goal that will require incremental change.
Other important policy changes include:
- Getting rid of the entire Veterans Administration (VA) health system would be a first goal and replace it with Health Savings Accounts (HSAs) that veterans with no other coverage can go anywhere with.
- Privatizing Medicare and the Federal Drug Administration should also be long term goals, with intermediate steps such as combining Medicare A, B, and D, expanding and reforming Medicare Advantage programs to allow patients more, not less, choice and increasing the age of Medicare eligibility.
- The FDA needs complete reform back to supporting basic science and approving innovative new medicines and treatments and stop regulating things like vaping and decreasing the bureaucratic red tape that is hurting, not helping patients. Terminally ill patients should have access to experimental treatments not yet approved as a matter of informed choice.
- We are opposed to any federal funding of research on human embryos, embryonic stem cells and cloning as barbaric and also not necessary and support states’ rights to prevent these activities.
- False barriers to professional practice, such as restrictive licensing laws also drive up costs and restrict consumer choice. We endorse state legislatures examining these issues.
- Costs are also driven up by risk avoidance. Each state should also consider tort reform, particularly in eliminating non-economic damage claims, frivolous law suits and statute of limitations excesses (such as in obstetrics).
We also believe that narrative that health care is too expensive and that all health care costs are bad is a false one. For the most part, healthcare attracts some of our best and brightest individuals and provides good jobs and good care. Keeping a vibrant health care industry with sufficient skilled workers is essential to our nation’s health. Although outside the scope of this document, barriers to health care professional education should also look for free market solutions.
Overall, we believe that we can continue to allow Americans to have the excellent, patient-centered health care that they chose and provide for those who need some help by free market solutions that put the patients back as the primary consumers and payers of the care, not government, insurance companies and employers.