Opinions are flying. Opinionators with a plan to fix healthcare in America are suddenly as common as waiters with a script in Santa Monica. Few are worth a second glance. They fall into the “that’ll never pass” pile or the “that’ll never work” pile.
So why should we pay any attention to Christopher Ruddy’s idea? Because he’s a prominent conservative, the CEO of Newsmax, and a long-time friend and ally of Trump—and he is advocating for at least a “lite” version of universal coverage.
Trump actually campaigned on universal healthcare, saying specifically that he meant a government-funded program that would “take care of everybody.” Ruddy argues that Trump is getting dragged into a political morass by abandoning the healthcare promises of his campaign and trying to go along with the Republican-controlled Congress. Instead, he says, Trump should dump Ryancare, shore up Obamacare, and appoint a bipartisan commission to come up with a replacement that could gather bipartisan support in the Congress. Ruddy suggests not “Medicare For All” but a stingier “Medicaid For All (Who Can’t Afford Insurance)” as a universal basic plan, with Health Savings Accounts and tax credits built on top of that for people who can afford, and want, more robust health plans.
Is this the best possible plan? No.
But it is the best idea put forward by a conservative friend and ally of Trump—and the only conservative plan that acknowledges the need to, as Trump said, “take care of everybody.” And events unfolding on Capitol Hill show that Trump may well need a Plan B.
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The point to me, the reason why I posted this, has nothing to do with whether Ruddy’s plan is the best, or even viable, or whether Ruddy is most on the inside, or is popular on the right. It’s to point out that Trump campaigned as a populist, promising healthcare for everybody, cheaper, government-subsidized if necessary. And if we follow his pronouncements over the years, it seems like this is actually a long-held belief, not a campaign gimmick.
Ryan is not a populist of any shape. In giving Ryancare his backing, Trump has seemingly thrown over his campaign promises and personal beliefs. Ruddy and Breitbart have repeatedly taken him to task for this. If we are to try to follow this excruciating attempt to reform the reform of healthcare and imagine where it is going to end up, this backlash from the populist right is really worth noting.
I should have added to #1 that anyone qualifying for Medicaid (strict qualifications) should be able to buy out of it if a relative or someone else were willing to assist them. Anyone not qualifying would have to pay a premium for Medicaid services. Medicaid should be a stepping stone to private insurance for those who need permanent assistance or those with sudden short term needs so its service should be limited.
Lets play this out:
1. Medicaid does not even pay for the lights to be on in our office. If they pay at all, it is almost criminal how low the fees are. If we are giving out free healthcare, then if you want to reduce waste, then anyone on universal medicaid, well, you do not get the luxury of suing for malpractice. Period. We can cut the price of healthcare by 30% right there.
2. If we don’t have to work to get healthcare, why work? We have many working poor that are actually doing themselves a disservice as they would be better not to work, as they would get food, housing and healthcare. We punish low income working people. That is a shame.
3. We need to decide if we are going to do universal medicaid, or let the market work itself out. The ACA and AHCA are just complex policy wonk programs that will never work. Complicated and tend to cause more problems and cost more than anyone could imagine.
4. As a MD, am I forced to provide this low pay universal medicaid? If so, I’m out. Cant afford it. If someone sues me for $1M for an office visit where they pay $13 how can I reconcile that? How do I tell the EHR companies don’t raise rates, or phone company or
electric company or equipment manufacturer, please HP reduce the price of your toner. Then you want me to data enter all my quality measures and improvement activities for this $13? I can find something else to do. Its too bad, because I am a really really good surgeon. And it takes 14 years of training and another 18 years of experience after to make another me.
Though this is not my favorite idea, it has validity. There are basically four points.
1)Medicaid for all
2)Robust private health plans
3)HSA’s
4)Tax credits
Off the cuff I would add the following.
1)Medicaid for all would be limited providing basic health care that would include the common cardiac and cancer modalities, though perhaps not the most recent or the most expensive and certainly proven to provide the standard method of judging feasibility based upon additional years of life, etc.
2)I would create a written healthcare plan for the private market to use only to compare one insurance plan with another. Insurers would use a type of rider system to add or subtract benefits from the basic plan. In that fashion all the insured needs to do is compare the riders, not the complex insurance contract making things more transparent. I would hold the insurer legally responsible for any lack of clarity since they are the experts and they are writing the contract. I would use the average man as the basis for what is or is not clear.
3)I would relax the laws for HSA’s and permit additions with after tax dollars.
4)Tax credits are fine, but since the best course would be to not have a tax deduction for healthcare I would not increase the tax credits and let them slowly disappear in the distant future.
I like it Joe. But two big problems with this :
1. Trump is not willing to set his own course on (non-wall and defense issues) when his political allies in Washington are willing to challenge him. Go read Paul Keckley’s post below. I think he’s probably right.
2. Ruddy is hugely unpopular with the Breitbart crowd. Do a quick Google search on him (as I did) and you’ll see just how unpopular.