Trump was right about health care for most of his life

March 31, 2017

Trump was right about health care for most of his life–Go Back to Basics

by Dr. Fareed Zakaria

Image result for Trump and Healthcare

Since becoming POTUS, DJT is under pressure

The recent Republican debacle on health care could prove to be an opportunity. It highlighted, yet again, the complexity of the U.S. system, which continues to be by far the most expensive and inefficient in the advanced world. But President Trump could actually use the legislative collapse to fix health care if he went back to basics and to his core convictions on the topic, which are surprisingly intelligent and consistent.

Image result for Kenneth Arrow

Markets would not work well in Healthcare

There is an understandable impulse on the right to assume that health care would work more efficiently if it were a free market, or a freer market. This is true for most goods and services. But in 1963, economist Kenneth Arrow, who later won a Nobel Prize, offered an explanation as to why markets would not work well in this area. He argued that there was a huge mismatch of power and information between the buyer and the seller. If a salesman tells you to buy a particular television, you can easily choose another or just walk away. If a doctor insists that you need a medication or a procedure, you are far less likely to reject the advice. And, Arrow pointed out, people think they don’t need health care until they get sick, and then they need lots of it.

Every advanced economy in the world has implicitly acknowledged his argument because they have all adopted some version of a state-directed system for health care. Consider the 16 countries that rank higher than the United States on the conservative Heritage Foundation’s Index of Economic Freedom. All except Singapore (which has a unique state-driven approach) have universal health-care systems that can be described as single-payer (Medicare for all), government-run (the British model) or Obamacare-plus (private insurance with a real mandate that everyone opt in). Hong Kong, often considered the most unregulated market in the world, has a British-style government-run system. Switzerland, one of the most business-friendly countries, had a private insurance system just like the United States’ but found that, to make it work, it had to introduce a mandate.

While producing a CNN documentary on health-care systems around the globe, I was particularly struck by the experience of Taiwan, another free-market haven. In 1995, 41 percent of its population was uninsured and the country had very poor health outcomes. The government decided to canvass the world for the best ideas before instituting a new framework. It chose Medicare for all, a single government payer, with multiple private providers. The results are astonishing. Taiwan has achieved some of the best outcomes in the world while paying only 7 percent of its gross domestic product on health care (compared with 18 percent in the United States). I asked William Hsiao, an economist who helped devise the country’s model, what lessons they took, if any, from the United States. “You can learn what not to do from the United States rather than learn what to do,” he replied.

Americans often assume that despite its costs, American health care provides better services than others. We often hear about the waiting time for care in other countries. But according to the Commonwealth Fund, among industrialized countries the United States is in the middle of the pack for wait times, behind even Britain . Moreover, one of the world’s leading experts, Uwe Reinhardt of Princeton, has found that Americans use less care than the average for developed countries when it comes to things such as seeing a doctor and spending time in the hospital. The problem with the free market is that there is little profit in prevention and lots in crisis care.

Trump has now taken up the call to repeal Obamacare. But until recently, health care was actually one of the rare issues on which he had spoken out, before his campaign, with remarkable consistency. In his 2000 book “The America We Deserve,” he wrote:

“I’m a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses. . . . We must have universal healthcare. . . . The Canadian plan . . . helps Canadians live longer and healthier than Americans. There are fewer medical lawsuits, less loss of labor to sickness, and lower costs to companies paying for the medical care of their employees. . . . We need, as a nation, to reexamine the single-payer plan, as many individual states are doing.”

Trump was right on this issue for much of his life. He has now caved to special interests and an ideology unmoored by facts. He could simply return to his convictions, reach out to Democrats and help the United States solve its health-care crisis.

11 thoughts on “Trump was right about health care for most of his life

  1. I would definitely opt for a single payer plan, probably the Taiwanese model which most likely the Democrats would embrace, or the Singapore model which work closer to the Republican ideal. What I found myself having no answer to is when Democrats within California is putting on the table a proposal of a single payer plan for the California State which covers the undocumented in the same pool of citizens borned in US. I definitely understand like air and water, healthcare should be consider a right to live. But, alas, when I wrap my head around that, that ideal itself is pushing towards the creation of a world without border. Frankly speaking, do we really have a world where all people want to live in ‘other’ people’s cultural system. I can only say I have no answer to this. I dream a dream where the wolf, tiger, and lamb live together .. Yet, it is so hard to be so generous at heart. I guess I begin to understand why Melayu would never give up their ‘special’ rights, even though it is crippling.

    • The deficiency with the Singaporean Medical Savings Account or Health Savings Account model (“Medisave”) is that the money in your forced savings account can only be used for the healthcare expenses of yourself and close family members.
      Thus, people who have low earnings will have low amounts accumulated in their Medisave accounts. Not easy to get Medifund, supposedly to help the poor, to help you defray your healthcare costs.

      The whole idea of social health insurance is to accumulate a pool of funds, have risk-pooling, and have the young subsidise the old, the healthy subsidise the sick, and the rich subsidise the poor in the spirit of social solidarity. In return, when the young get old, and the healthy get sick, others will subsidise them.

  2. Why has there been no debate and no demand about healthcare cost in the future in Malaysia? The current system must change and by right, the sooner the better to keep future cost low.

    It’s especially important to debate this in Malaysia given the prodigality of Najib and the over entitlement of both UMNO and Hadi’s PAS. The cost in the future will start to rise rapidly once we start aging in about 10 years.

  3. On papers, the Taiwanese healthcare is ranked third best in the world, but it is not without great problems, especially in short consultation times time and poor gatekeeping of specialist services. I know, because my son-in-law is a GP from Taiwan.

    To ensure their incomes are maintained, it is quite common for GPs in Taiwan to seeing 50 patients in a morning. Hence, each patient may receive no more than five minutes of physician time during a consultation. Such short contact time may result in poor patient–physician rapport and inability to deal with complex problems in one visit. As a consequence, patients often attend for a second or a third opinion, thus contributing to even higher patient volume and higher medical costs.

    Taiwanese are able to choose their healthcare providers freely. One consequence of easy accessibility to specialists is that the ‘gatekeeper’ role of family doctors is relatively weak in Taiwan. Having no gatekeeper means there is no check on whether Taiwanese use specialty healthcare appropriately. Large medical institutions are always at full capacity from patient admissions, and patients may find it difficult to get admitted, while the number of middle sized hospitals is shrinking progressively.

    As in the health systems of many countries, significant financial problems exist in Taiwan. The payment systems for healthcare providers are formulated in global budget and based on the care provided. The new pharmaceutical agents and medical technologies that emerge also pose financial dilemmas to the health system. Currently, the Taiwanese National Health Insurance (NHI) does not take in enough money from premium payment to cover the entire healthcare provided by the hospitals and other healthcare personnel. The government often has to provide additional funds to keep the system running. The problem is complicated by politics because any premium increase would require the approval of the Legislative Yuan (Parliament).

  4. I think the whole world (especially governments and their bird-brain legislators) have got the issue of ‘universal’ healthcare backside up – only to be buggered by mercenary bean counters and insurance scammers.

    I’m not an expert in public health, but i have been a clinician for almost 40 years. What i propose is common sense and use of reason – in the words of Schumacher “Small is Beautiful”.

    Let’s just revise the whole she-bang of “Big is Better” when it comes to health and medical care, which has become a top down FUBAR beyond redemption.

    Localize it on a community basis – starting with Nurse Practitioners, Midwives, GPs, Family Practices and small local hospitals within communities. Local hospices too. These receive a stipend or subsidy from local authorities derived from local household taxation. Next level up, to regional general hospitals, then to state-owned referral centers and finally to federal specialist centers – each with ascending spending, derived from a universal low-level income and corporate taxation. Medicolegal litigation must be controlled.

    Excessive Profitability should never be an issue in public service. That of course, would make nursing and medicine more, not a less rewarding a career for those who are ‘called’. Cut out the middleman.

    There must be strict gate-keeper policies and reasonable speed of referrals – which require a standardized template.

    Cuba’s medical and health care is remarkable for a small, sanctioned fut isn’t it? Heck. they even had the audacity to co-develop the Meningococcal B vaccine while the stupendous western Big Pharma were scratching the groins situated on their heads..

    • Theres a variation called Concierge Medicine that has been practised in the US and gaining traction. From wikipedia.
      Concierge medicine (also known as retainer medicine) is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges. In exchange for the retainer, doctors provide enhanced care, including principally a commitment to limit patient loads to ensure adequate time and availability for each patient.[1]

      The practice has been referred to as concierge medicine, retainer medicine, membership medicine, cash-only practice, and direct care. While all “concierge” medicine practices share similarities, they vary widely in their structure, payment requirements, and form of operation. In particular, they differ in the level of service provided and the fee charged. Estimates of U.S. doctors practicing concierge medicine range from fewer than 800[2] to 5,000.[3]

      In the US there is a shortage of Family Practice physicians and has reached a point where patients who cant wait to see the Primary Care Provider are turning to Urgent Care Centers where its a walk in scenario for treatment of regular illnesses and including minor surgeries. Serious cases are still sent to ER.

  5. Those who can afford it should not crowd the Health Services provided by the State but should instead use the Private Health Services. One of the ways to make the services provided by the state efficient is to provide financial assistance for those who cannot get timely medical services from the state to use Private Health Services. And take politics out of Health Services.

  6. I don’t think one can beat the National Health Service (NHS) for its founding principles of being comprehensive, universal and free at the point of delivery.

    Over 10 years ago, I had a heart attack playing golf in Malaysia. I had an angioplasty which cost me about £4000. It was fine cause I had travel insurance.

    Now, I take about 6 different medicines everyday and they are all free. The angioplasty would have been free too if I had been in the UK. That’s the NHS for you. Best thing since slice bread.

    • Political right-wingers have not been able to do away with the NHS in England because of its popularity.

      Now they are trying to change it by other means e.g. contracting out, PFI hospitals and so on.

      Suggest to read the writings and watch the videos of English professors Allyson Pollock and John Lister.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.