On the one hand, personally, I’m a nice, patriotic, idealistic person.
I tear up at the sight of the U.S. Capitol and the White House, and I believe, deep down — possibly in the same part of me that still believes in the Tooth Fairy — that anyone who becomes president must feel a sincere sense of awe and terror.
I think that, if any of the major candidates who are still in the U.S. presidential race becomes president, he or she will appoint fine advisors, listen to them carefully and, in the end, make reasonable decisions, on health policy as well as in connection with other matters.
On the other hand, it’s hilarious to see that one of Donald Trump’s major proposals for replacing the Patient Protection and Affordable Care Act (PPACA) is to let people leave the assets in their health savings accounts (HSAs) to their heirs.
On the third hand, few of the people bashing Trump have tried to put out any PPACA replacer proposals of their own, and few of the proposals that are out there look serious to me.
So, what standards should a “serious PPACA replacer” meet, other than, “I should like it”?
Here are ideas for standard health policy literacy requirements, and ideas for questions that anyone who wants to change, replace or keep PPACA ought to answer.
Health policy literacy requirements:
Candidates who want to weigh in on health policy should show that they understand that the public exchange system, Medicaid expansion, the individual coverage mandate, and the birth control coverage mandate that the U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius bolted onto PPACA are just small parts of PPACA. Does the candidate really want to repeal the parts of PPACA that don’t affect commercial health insurance, and, if so, why?
Candidates who are trying to change the system should talk a little about their own health coverage and show they have a basic understanding of how it works or doesn’t work.
Some questions that anyone making the proposal should ask themselves:
1. What role, if any, do you think the federal government (or state governments acting at the direction of Congress) should play in paying for health care for civilians?
2. What role, if any, do you think nonprofit insurers and nonprofit health care providers should play? What about for-profit insurers and for-profit providers?
3. What percentage of the gross domestic product, if any, do you think the federal government (or state or local governments under federal direction) should be willing to spend on health care?
4. How much do you think your PPACA replacer proposal (or proposal to keep PPACA more or less as-is) would cost, and save? Where would you get the money to pay for your proposal? Please give details about the assumptions behind your cost, savings and revenue estimates.
5. How do you think your strategy would affect the percentage of children, low-income working-age adults, moderate-income working-age adults, high-income working-age adults, and people ages 65 and older who have insurance? How do you think your strategy would affect the percentage of those working-age adults who have annual out-of-pocket spending maximums under 5 percent of their annual household income? How would it affect the percentage of people in each of those categories who would be unable to qualify to buy health insurance at any reasonable price?
6. If you are proposing any new taxes or other revenue-raising measures: Discuss how you think those might affect what resources consumers have to spend on non-health-related goods and services, and the resources society as a whole has to spend on education, public safety, defense, science and commerce.
7. Please discuss how your proposal would affect:
A 5-year-old with hemophilia.
A healthy 40-year-old who earns $30,000 a year, never goes to the doctor, can barely pay the rent, and would rather have a decent apartment than health insurance.
An uninsured, obese 30-year-old with high blood pressure who wants to buy health insurance.
An insured 45-year-old who needs a liver transplant.
An always-insured 50-year-old with hard-to-control diabetes.
A 70-year-old who has Medicare but does not qualify for Medicaid.
- The owner of a company with 55 employees who wants to provide health benefits without being a PPACA rocket scientist.
8. If you said that you think the federal government should play a role in paying for civilian health care, and money runs short, how should health programs handle the funding gap?
Leave a gap in the amount of medical care patients get. (Please discuss the possible economic and humanitarian effects of that strategy.)
Raise revenue by imposing fees and taxes. (Please discuss the possible economic effects of that strategy.)
Make health care providers accept lower reimbursement rates. (Please discuss the possible effects of that strategy on the supply of health care goods and services.)
Other. (Please describe your preferred strategy and its possible effects on the national economy, patients’ well-being, providers and the job market.)
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