The U.S. spends 18% of GDP (and rising) on healthcare, public and private, almost twice as much as any other developed country. The Affordable Care Act, passed by Congress and signed by President Obama in 2010, increases access to healthcare in the U.S. but does nothing to control its cost.
President-elect Donald Trump and the Republican Congress want to repeal the ACA and replace it with a more effective and less expensive alternative. An excellent plan for doing this, “Transcending Obamacare” has been proposed by Avik Roy, the President of the Foundation for Research and Opportunity. Mr. Roy’s Universal (and refundable) Tax Credit Plan will:
- expand health insurance coverage well beyond ACA levels without an individual mandate
- improve the quality of coverage and care for low-income Americans
- achieve permanent solvency of U.S. healthcare entitlements
- reduce the federal deficit without raising taxes
- reduce the cost of health insurance for individuals and businesses
Here are the main elements of the Universal Tax Credit Plan:
- Premium assistance. The Plan repeals the ACA’s individual mandate and expands access to health savings accounts. By lowering the cost of insurance for younger and healthier individuals, the Plan would expand coverage beyond ACA levels.
- Employer-sponsored insurance reform. The Plan repeals the ACA’s employer mandate, thereby offering employers a wider range of options for subsidizing workers’ coverage.
- Medicaid reform. The Plan migrates the Medicaid acute-care population onto the reformed private individual insurance market, with 100% federal funding. The Plan returns to the states full financial responsibility for the Medicaid long-term care population.
- Medicare reform. The Plan gradually raises the Medicare eligibility age by four months each year (forever), allowing younger retirees to remain on their existing plans.
- Veterans’ health reform. The Plan gives veterans the option of private coverage via premium assistance.
- Medical innovation is encouraged by the Plan.
Conclusion. The Universal Tax Credit Plan is a big improvement over the ACA because it expands access, improves quality and dramatically lowers costs for both individuals and the country as a whole. Check it out!
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It Does Not Add Up 
Nationally, we continue to ignore the local attributes that effect each person’s health. A Special Report appeared in an April 2016 edition of JAMA (Journal of the American Medical Association). It used de-identified data from the IRS ( income ), the Census Bureau ( Census tract attributes, county by county ) and death certificate cause and age of death with associated address ( Vital Statistics from the Communicable Disease Center). All of this for a 15 year period 1999 to 2014. Lots of information here, but one result is most revealing. People living amidst poverty usually have a shorter life span. BUT, there many census tracts where this did not occur in spite of the presence of poverty. This observation occurred in community’s where ‘all’ of its citizens had a more prevalent level of college education. The authors explored several possible explanations with no answers found.
Comment: This is an amazing study. There are three Editorial Comments in the same JAMA edition. The second Commentary of the three used the concept of ‘social capital’ and its connection to a community’s ‘common good’ as the explanation. This logic is connected to an assumed higher level of Altruism associated with advanced education. Defined by a Merriam Webster dictionary, altruism represents ” unselfish regard or devotion to the welfare of others.” Presumably, college education would be associated with a higher prevalence of altruism. The altruism would promote an associated ‘halo’ effect throughout the community to produce a powerful effect on the support of those surviving with low income.
The implication would be that there may be other communities with similar levels of poverty and altruism but no protective effect. If that is possible, there are probably many factors, on a population basis within a community that are totally unrecognized. Currently, this concept has no recognition within our nation’s healthcare reform. One more time, I need to acknowledge the intent of the Cooperative Extension Service, county by county, to assist the local rural or urban farmer since 1914. As a result, our nation’s agriculture industry is the most efficient and effective among all of the world’s developed Nation’s, AND our nation’s healthcare industry is clearly the least efficient and unacceptably effective among these same developed nations. The Design Principles (defined by Nobel Prize winner, Elinor Ostram) for managing a commons should apply, as in the portion of our GDP devoted to healthcare. We only lack the will to fix our healthcare industry once and for all, community by community.
Twiddling/dithering with the economic payment process is important to achieve uniform health insurance. But, there is absolutely no evidence, so far, that alternate payment mechanism’s have done anything but increase its overall cost at a rate higher that the growth of our nation’s economy. Another realignment for the application of resources for each citizen’s Basic and Complex Healthcare Needs is unlike to reduce the portion of our nation’s economy to less than 13% (now 18%). This means that the increase in the cost of health care, on average, will need to be @1% (@25% less) under the annual growth of our nation’s economy for at least 10 years. My own estimate is that with a very carefully planned and executed strategy we can reduce the cost to 11% of the national economy as a means to stimulate its more rapid growth rate.
For you to predict that healthcare costs can be reduced to just 11% of GDP means that you must have a fairly definite healthcare delivery model in mind for achieving this.
I think it would be very useful for you to provide a general outline for a model which will accomplish this. Perhaps this is what you have in mind when you announce on your website what is coming in 2017.