Meet the Doctor Trump Picked to Dismantle Obamacare

万得福

President-elect Donald Trump’s selection of Rep. Tom Price of Georgia as the next secretary of the U.S. Department of Health and Human Services is an outstanding choice.
It is hard to imagine a candidate more qualified to serve in this crucial position, especially at a time when America’s health care economy is undergoing a major transition. He is not only a well-schooled expert in the nuances of complex public policies, but also an excellent communicator and debater.
An orthopedic surgeon by profession, Price began his public career as a member of the Georgia state Legislature. With over 12 years of service in the House of Representatives, including his service as chairman of the pivotal House Budget Committee, he has emerged as one of the most knowledgeable and effective members of Congress on federal budget and health policy.
Given his background as a state official, one can expect that he will be especially supportive of innovative health reforms at the state level.

Price’s approach to health policy, in particular, is best understood by an examination of his legislative record. He is the author of numerous bills and amendments, most notably the Empowering Patients First Act, a highly detailed legislative proposal that would repeal the Affordable Care Act and replace it with patient-centered provisions that would control costs and expand coverage in the private health insurance markets.
A number of Price’s proposals have been incorporated into the House Republican alternative to the failing Affordable Care Act, proposed under the leadership of House Speaker Paul Ryan.
Price’s measure would provide individual tax relief for health insurance for Americans to own and control their health insurance policies, just as they own and control their life insurance policies, making coverage fully portable and secure, from job to job and through different stages of life, without today’s outdated tax or regulatory penalties.
Patient choice of coverage combined with intense competition in the health insurance markets would not only control costs, but also stimulate innovation in benefit design and health care delivery.
By providing individual tax relief for health insurance, Price’s measure would remedy the central weakness in America’s health insurance markets, long recognized by health policy analysts and economists, including the late Nobel laureate Milton Friedman: the inflationary, dysfunctional, and inequitable federal tax treatment of health insurance.
Price has also proposed the creation of independent health insurance pools for more affordable coverage in the individual and small group markets, and also a change in the law allowing association health plans, enabling small business owners to band together across state lines.
Moreover, similar to Trump, Price supports strengthening and enhancing health savings accounts by allowing increased contributions and greater flexibility in the use of these accounts, as well as permitting individuals to buy health plans licensed in other states.
For ordinary Americans, the best reason to celebrate Trump’s choice: Price himself is a doctor. Today, doctors are demoralized by the reams of rules and regulations and paperwork imposed on them by politically-driven, bureaucratic third-party payment arrangements—a morass eating into their precious time and energy. Their patients, of course, are the ones who suffer the most.
With Price taking the helm of American health policy, doctors and patients alike have sound reasons to hope for a welcome and long-overdue change.

万得福

Health Care Reform: Changing the Tax Treatment of Health Insurance

By Greg D'Angelo and Robert E. Moffit, Ph.D.

Leading Members of Congress and certain officials in the Obama Administration are reportedly considering changes to the federal tax treatment of health insurance as a means of financing health reform.[1]

If there is one area in health policy where there is a powerful consensus among serious analysts, conservative and liberal alike, it is the need to change the existing tax treatment of health insurance.[2] President Ronald Reagan first proposed a change to the tax law governing health insurance in 1983, but Congress never acted on the proposal. Six years later, analysts at The Heritage Foundation unveiled a national health reform proposal grounded in comprehensive tax reform.[3]Now, the idea could-depending on its details-potentially serve as the basis of a bipartisan compromise on health reform in the coming months.

The Current Tax Treatment

The current tax treatment of health insurance is a byproduct of wage and price controls imposed by the Roosevelt Administration during the World War II era. The federal tax code currently excludes, without limit, the value of employer-sponsored health insurance from an individual's income for the purposes of both income and payroll taxes. This tax exclusion for employer-sponsored insurance is a huge, but hidden, tax subsidy. The Joint Committee on Taxation estimated that value of the tax exclusion in 2007 was $246.1 billion in foregone income and payroll taxes.[4] The exclusion represents the largest federal tax expenditure as well as the third largest health care expenditure, following only Medicare and Medicaid, the nation's two largest entitlement programs.

Health economists generally agree that this Roosevelt-era policy is poorly designed and has many perverse incentives.[5] The employee exclusion is inherently unfair, inefficient, and inequitable.

It is unfair because only individuals with employer-sponsored insurance are able to receive tax relief, while individuals without access to such coverage typically pay for health insurance with after-tax dollars and, in effect, face a sizeable tax penalty. It is inefficient and inequitable because the largest tax benefits go to those who need them least; given the progressive structure of the tax code, the exclusion is regressive since it is worth less to taxpayers in lower marginal tax rates and more to those in higher marginal tax rates. Therefore, if the goal is to extend coverage to the uninsured, the tax break is poorly targeted because it provides little or no tax relief to those with low incomes, who are least able to afford health insurance.

The tax treatment of health insurance also has the perverse effect of increasing health care spending and driving up costs by essentially lowering the effective price of employer-sponsored health insurance. The exclusion does encourage individuals to obtain insurance. But it also encourages many individuals to have more generous insurance than they typically need, because the higher the cost of the insurance and the higher the person's income, the bigger the tax benefit for the individual.[6] The exclusion creates a bias toward overly generous insurance-even first-dollar coverage-with low cost-sharing in the form of co-payments, coinsurance, and deductibles because out-of-pocket expenditures, for the most part, do not enjoy a similar tax preference. This incentive reduces the price sensitivity of health care consumers and leads to higher prices and greater utilization, which in turn puts a strain on resources and makes health care more expensive for those who lack insurance.

The Right Way to Change the Tax Treatment

The best way to change the current tax treatment would be to replace the existing tax exclusion with a more equitable and efficient system of individual tax relief, leveling the playing field for robust competition among insurers and creating a level of consumer choice that is routine in every other sector of the American economy.

Short of that, Congress could limit or cap the exclusion, perhaps only for income tax purposes, while simultaneously using the new revenue to provide health care tax credits for taxpaying households. The government could also provide vouchers-which, for lower-income households, could be combined with the credit-so that more individuals and families can afford health insurance.

Under this scenario, any revenue generated from the value of premiums that either exceeds the cap or is no longer excluded from taxable income should be used exclusively to finance tax credits to individuals and families to offset their federal taxes. The existing tax exclusion on health benefits should be gradually phased out over time while the new system of health care tax credits for individuals and families is phased in. The health care tax credits should apply to a significant portion of a health plan's premium-but not all of it (consumers should have some "skin in the game")-and be used to offset some of a taxpayer's income tax liability.

Americans with no tax liability, or tax liability that is currently less than the value of the credit, should receive vouchers to purchase their own insurance. The voucher component would be somewhat like a traditional refundable tax credit (such as the earned income tax credit), although with a key difference: These health care vouchers should be paid for entirely by reductions in other government spending in the budget-and there are plenty of options available to finance such direct assistance to low-income persons. But assistance to families currently not paying taxes should not be funded by the revenue raised from changes in the tax treatment of health insurance for taxpaying Americans.

Essential to Bipartisan Reform

Changing the tax treatment of employer-sponsored health insurance has for years enjoyed support from across the political spectrum. Although President Obama has not yet included tax treatment reforms in his health care plan, it is not too late. Senate Finance Chairman Max Baucus (D-MT) has proposed limiting the current tax exclusion, which suggests there is still some room for a compromise on this front. If President Obama and leaders in Congress are sincere about passing-and fully financing-comprehensive health care reform legislation with broad bipartisan support, changes to the tax treatment are essential.

There are several ways to design a new system of health care financing that is more efficient and more equitable than what Americans have today. The right way is to restructure the tax code to promote competition among health plans and give Americans real personal choice of health care options. A proposal that gradually phases out the current income tax exclusion while phasing in a more equitable and efficient tax treatment will achieve serious bipartisan health care reform.

Greg D'Angelo is Policy Analyst in and Robert E. Moffit, Ph.D., is Director of the Center for Health Policy Studies at The Heritage Foundation.

[1]Lori Montgomery, "Workers' Health Benefits Eyed for Taxation: Revenue Would Fund Expansion of Coverage," The Washington Post, March 12, 2009, at http://www.washingtonpost.com/wp-dyn/content/article/2009/03/11/AR2009031
103827_pf.html (March 13, 2009);see also Jackie Calmes and Robert Pear, "To Pay for Health  Care, Obama Looks to Taxes on Affluent," The New  York Times, February 25, 2009, at http://www.nytimes.com/2009/02/26/us/politics/26budg
et.html?pagewanted=1&_r=1 (March 13, 2009); see also Jackie Calmes and Robert Pear, "Administration Is Open to Taxing Health Benefits," The New  York Times, March 15, 2009, at http://www.nytimes.com/2009/03/15/us/politics/15h
ealth.html?ref=politics (March 16, 2009).
[2]See John Holahan and Linda J. Blumberg, "An Analysis of the Obama Health  Care Proposal," Urban Institute, 2008, at http://www.urban.org/
UploadedPDF/411754_obama_health_proposal.pdf (March 13, 2009). See also Henry J. Aaron and Leonard E. Burman, eds., Using Taxes to Reform Health Insurance: Promises and Pitfalls (Washington, D.C.: Brookings Institution Press, 2008).

[3]Stuart M. Butler and Edmund F. Haislmaier, eds., A National Health System for America (Washington, D.C.: The Heritage Foundation, 1989).

[4]Joint Committee on Taxation, "Tax Expenditures for Health  Care," July 30, 2008.

[5]See for instance Katherine Baicker, testimony before the Committee on Finance, U.S. Senate, July 31, 2008, and Jonathan Gruber, testimony before the Committee on Finance, U.S. Senate, July 31, 2008, at http://finance.senate.gov/sitepages/hearing073108.htm (March 13, 2009).


[6]Jason Furman, "Reforming the Tax Treatment of Health  Care: Right Ways and Wrong Ways," in Aaron and Burman, Using Taxes to Reform

kaleege

我预测放这里，四年后再看准不准。

川普治下，healthcare照样涨价不误。
只不过obama期间healthcare涨价，右派都骂obama。
川普期间healthcare涨价，右派都将自戳双目，变成瞎子，对川普照舔不误。

万得福

kaleege 发表于 2016-11-30 11:28
我预测放这里，四年后再看准不准。

川普治下，healthcare照样涨价不误。

哦？你有什么高招？展展呗。

万得福

For nearly 20 years, Dr. Price worked in private practice as an orthopedic surgeon. He was first elected to represent Georgia’s 6th District in November 2004. Congressman Price has steadfastly introduced variations of his current House Resolution 2300, Empowering Patients First Act, into numerous Congresses.


11. Can you give us in a nutshell what differentiates H.R. 2300 from not only Obamacare but other plans as well?

We started with a clean slate when I chaired the Republican Study Committee, which was before Obamacare passed. We had 20-25 members, some with a healthcare background – some without, who identified principles held dear by Americans. These are the principles mentioned earlier:  accessibility, affordability, quality, choices, responsiveness, and innovation. We then addressed what a healthcare system guided by these principles would look like. We believe a healthcare approach should:
•Cover everyone without Washington being in charge.
•Solve the insurance challenges of portability and pre-existing conditions that are woefully wrong in the current system.
•Save hundreds of billions of dollars every year with lawsuit abuse reform.
•Place patients in charge of their healthcare and enabling them to own their coverage.
•Equalize tax treatment.

12. What role do you see the Federal Government playing in your plan?

Over the last 50 plus years, the role of the Federal Government has become broader and more expansive, especially in the area of healthcare. We have to wind this down so patients are back in charge of their healthcare. For example, it is illegal for doctors to treat Medicare patients in ways not stipulated by Medicare guidance. It’s a felony to do so. The government must back out. The healthcare system needs to be flexible, allowing for treatments that doctors and patients deem best for the patient. We must look at areas where the government touches healthcare and end or modify that activity, based on the healthcare principles stated above that place the patient at the center of healthcare decision-making.

13. How will H.R. 2300 help the needy?

It’s a fallacy that the government is responsive to patient needs. Medicaid is going broke and is terribly broken. It is not responsive to patients. A recent study shows patients with no healthcare coverage received higher quality care than those on Medicaid. The challenge is how to provide the best care for the patient. The answer is the patient must have the flexibility, freedom, and liberty to choose healthcare coverage. H.R. 2300 offers this through the tax code with tax deductions, credits, advanceable credits, and refundable advanceable credits. The plan calls for all people to receive coverage, regardless of their financial status. It offers people the financial incentives to purchase the healthcare coverage that they need. Obamacare requires people to buy healthcare coverage that they may or may not need.

14. How will you provide healthcare for illegal immigrants?

That’s a huge challenge. I do not conflate healthcare for Americans and healthcare for illegal immigrants. The latter is a completely separate problem. The issue of those here illegally needs to be solved. The challenge is huge. But when we combine the two, then we ignore the kinds of separate healthcare solutions required for Americans and those here illegally.

万得福

By Thomas R. WadeInsurance for the last few decades has been primarily been funded through employers. Graphically it looks similar to the picture below. This plan restricts the employee from choosing his or her own insurance company. The employee is limited to the choices made by the employer unless they want to buy their own insurance with their own money.
Limited Choice Employer Based Plan

Limited Choice Employer Based Plan (Wade Diagram)

In the last decade, we have seen where the health savings account has developed, but this is a short-sighted band-aid to a real problem. There are some good features to the health savings accounts, but they are minor to the real savings we can achieve for everyday Americans.
The plan described below combines many good ideas that are in the news today. The plan allows the employer to make direct deposit to a health savings account owned by a married couple rather than to the individual’s health savings account. The couple can then purchase the insurance plan they want.
Individual Based Plan with Freedom of Choice

Individual Based Plan With Freedom of Choice (Wade Diagram)

The principle is for the employers to make a tax deductible contribution to a health savings account just like they do for your paycheck. Then, in the situation above, the couple uses the clout from two employers to buy one insurance plan for the family. There are thirteen basic advantages this plan has over the conventional health care company based plan we have been using.
First—The individual and maybe the spouse if there is one get to pick the insurance company and not the employer. The man’s employer under the old system may have United Health Care and the woman’s employer may have Humana. The family may want Anthem Blue Cross. With this plan the couple has freedom to choose the plan that is optimum for their own family. They can still get one of the plans the company has negotiated for them or they can go directly to an insurance company or they can go through a network like Costco or the church or some civic organization.
Second—The married couple gets to share an account. I cannot remember a time when it was not more affordable for my spouse to get her insurance through her employer and for me to get my insurance through my employer, and then we would have to pick one or the other for the children. So normally, I would not be on the same plan as my children. This was the least expensive way for my family. When you look at the numbers though, if I was able to use the contribution from my employer and combine it with the contribution from my wife’s employer and buy one insurance plan, we would have had extra funds every month instead of having to further supplement both plans.
This is the most important point so I am going to try to give an example that is understandable so cost savings are understood. With numbers from 2012, under the old plan, an employer would contribute $900 for a $1350 plan covering her and the two children, and my employer may contribute $400 for a $533 single plan for me. The total contribution from us to the two plans would be $550 per month.    With my plan, the employers make the same contributions to the health savings account instead of to an insurance company. Now the family only pays $50 a month instead of $550 per month. The family saves $6000 per year.
Let us also take a worst case scenario so that we can see the range. With numbers from 2014, under the old plan, an employer would contribute $700 for a $958 plan covering her and one child, and my employer may contribute $383 for a $486 single plan for me. The total contribution from us to the two plans would be $361 per month. With my plan, the employers make the same contributions to the health savings account instead of to an insurance company. Now the family only pays $305 a month instead of $377 per month. The family saves $864 per year. There are several websites online that reveal average numbers and using the numbers from any one of them ends with a positive savings from this plan. There is a loss of scale by buying insurance individually, but that can be made up by buying insurance with an organization, such as Costco or the church or civic organizations.
Third—Also very important is now the family has only one deductible to meet each year so there is going to be savings here as well.
Fourth—The family can now start saving money in the account for insurance in retirement.
Fifth—Loss of employment. If the family can save a few thousand in the account and one of the couple loses a job, then there are some funds to help pay for the insurance during unemployment.
Sixth—The family learns how to become more responsible for their own health and the costs associated with it. The couple will be more demanding from doctors in what tests are really necessary and what are frivolous and stop relying on insurance companies to negotiate lower rates when all it does is drive up costs. In case you did not know, doctors give discounts when you do not use an insurance company.
Seventh—Either one of the couple can move from job to job, and the couple can keep their insurance company. I think without too much convincing, I can really say, if you want to keep your doctor, you can keep your doctor. You can quote me on that if someone has not already beat me to it.
Eighth—Pre-existing conditions are no longer a concern. Pre-existing conditions have only been a concern because an employee transfers from one job to the next changing their insurance plan—once again because the employee is locked into what the employer offers. With this plan, the citizen gets to keep their insurance plan as they move from job to job so pre-existing condition concerns become extinct.
Ninth—The employer does not have to have a person or department dedicated to negotiating and administering the insurance for their company. This is a real benefit that you may or may not choose to exploit. Companies, like DuPont, probably have hundreds at all their plants that take care of this nuisance. These are non-productive jobs in our society. Sorry folks.
Tenth—A child of the couple can start working at age fifteen and start their own health savings account that may accumulate a few thousand by the time they get through school and their first year or two on the job. The child could transfer the savings to their parents account and then stay on their parents insurance or just save the money for when they are on their own and still stay on their parent’s plan. There would be no age limit with this plan, because the entire idea revolves around the individual family and the insurance company.
Some insurance companies may decide to offer multigenerational policies as part of an aggressive marketing plan. Age limits have been installed so insurance companies can set offer packages to employers for the employees. If a couple chooses to buy insurance other than what the employer offers, age restrictions would not apply.
Eleventh—I forgot to tell you that the woman’s employer is the Catholic Church, and they no longer are responsible for buying the insurance and they do not know what insurances the employee gets.  They do not know if the woman is buying birth control, and it is no longer an issue.
Twelfth—I also forgot to tell you the woman used to be in the Army and might now get a monthly stipend to help pay for insurance from the VA. Now we can direct the Veterans hospitals to administer care only for wartime injuries, including PTSD. The Veterans hospitals can focus and become specialists in wartime injuries. The Veterans Administration no longer has this huge burden of providing normal health care to veterans, and the waiting period at a Veterans hospital will go way down.
The first eleven ideas can be implemented immediately without too much coordination, and, of course, number twelve will take quite a bit of work but should be still easy. And now for number thirteen, which will take quite a while to implement.
Thirteenth—Medicare can also be built right into this plan with contributions from employers going to a sub-account within the health savings accounts instead of to the government. The end result will be beautiful, but the road to get there will be difficult. This may take 50 years to phase in as we also take 50 years to phase out benefits.
Adding to this comment, we have always tried to solve problems overnight instead of providing a guideline for the problem to work itself out. As an example, we gave someone right out of the box a social security check for which no donations had occurred over the course of a lifetime. We could have provided for a 401K-type of system and let the problems work itself out over time. Instead, a leader took advantage of power with no foresight—a common problem among leaders.
RequirementsCongress will have to lay out guidelines on transferring savings from one HSA to another, like from a teenager to an adult or from a passed away parent to the child, or from an ex-husband to an ex-wife for alimony. Rules will also have to be laid out for record-keeping and maintaining tax records.
ConclusionThis will restore confidence of the American people in their leaders by providing a guideline and pathway for citizens that are easy to follow and the least expensive to implement. This by itself does not necessarily wipe out the Affordable Care Act. It does however provide a path for American citizens to forge their own futures with a little independence from their employer and government intervention.