President Trump could provide extraordinary leadership by leapfrogging over the miserable mess of a health care proposal now before him and doing something really monumental. In one stroke he could repeal and replace Obamacare in a way that would:
- Keep his promise to provide high quality health care to all Americans at lower cost;
- Rescue American companies from the crushing $18,000-per-employee tax they now pay for overpriced health care, hampering their competitiveness in the global markets;
- Seize the most potent negotiating position in a business generating $3.2 trillion dollars of revenues annually;
- Use that negotiating power to drive excess costs down by big double-digit percentages;
- Own the biggest and best health care brand in America.
And the good news is that President Trump already knows exactly how to do it, as he said in his book The America We Deserve: “We must have universal healthcare… We need, as a nation, to reexamine the single-payer plan…”
Now he’s in a position to take that proven winner called Medicare and make it universal: Medicare for All. Everybody knows it has the highest user satisfaction in the health care world, and it also gets the biggest bang for the buck.
The reason Medicare is such a winner is simple: as a big buyer, it can negotiate terms with its suppliers. By contrast, the for-profit insurance companies are too fragmented to drive any deals—but worse, they don’t even want to!
Listen to this: I was an executive of a company making a medical-device whose use in the operating room was proven to shorten hospital stays, reduce readmissions, and limit PTSD from surgical mishaps. So I took our company’s medical director with me to meet with the medical director of a massive insurance company. We presented our Class I research data that showed how much money is saved by avoiding those expenses (not to mention avoiding the patients’ pain). Use of our device cost only $17 per surgical patient. We proposed that his company promulgate its use (as, in fact, the Joint Commission on the Accreditation of Health Care Organizations subsequently did in one of its rare “Sentinel Event” alerts—resulting in its currently being used more than fifteen million times a year).
His response: “We don’t care about that. We don’t care about cost. That’s not our job. Look, if the patient happens to incur extra expenses, that’s no skin off our nose. We just raise the next year’s rates to cover it, and our customers pay the bill.”
Right there we see the reason the Republican plan to control costs is hopelessly dim-witted: there is a massive difference between the “aggregate cost” of American health care (i.e., $3.2 trillion annually) and the “billed expense” of care for any given patient (which may include hospitalization, procedures, pharmaceuticals, or medical devices).
The Republican plan aims only to slash aggregate cost by slashing the number of Americans whose billed expenses its plan will cover, and then slashing coverage for any covered patient’s care. This is both cruel and hopeless, a vicious circle that can only end in excessively high-priced care for those few who can still afford it and disgracefully ill health for all the rest. And it perpetuates the anti-competitive $18,000-per-employee tax on American businesses, while further luring them into hiring hordes of less effective part-time workers to avoid paying health care premiums required of the fulltime employees who would be so much better.
The real target should be slashing the excessive expenses any patient incurs due to things like profiteering pharmaceutical prices, irrational overtreatment of a patient by a physician worried about malpractice lawsuits, and other unnecessary expenditures well documented by keen observers of this out-of-control industry. President Trump knows the art of the deal is about winning, and the only way to win in health care reform is by controlling excessive expenses, not by limiting who gets to be healthy and who doesn’t. And being the big dog, the single-payer, is the only way to do that: Medicare for All.
Of course, he can expect a lot of pushback from the for-profit insurance companies who are making lots of money for intermediary services we don’t need. But he can handle that: America comes first. Companies like United, Anthem, Aetna and the others are the buggy-whip manufacturers of modern-day health care, and their day is simply over.
Yes, it is something nor ordinary politician would dare. But then President Trump is certainly no ordinary politician, and Medicare for All could go down in history as the most incredible deal any President has pulled off since the Louisiana Purchase.