Anti-Trump progressives are shouting the now-ascendant Republicans are going to “take away your healthcare” and “deny Americans their ACA insurance.” Bravo! Because if that happens then finally, maybe, Americans might get the health…care they need when they need it without declaring bankruptcy.
There is healthcare, health insurance, and health care: all different yet frequently conflated. Healthcare as one word is a massive, byzantine system that consumed nearly 18 percent of U.S. GDP in 2023 ($4.9 trillion, more than the entire GDP of Japan.)
Health insurance is a promissory note to deliver specified “benefits” (medical care) in return for a premium paid. Such insurance is widely considered, albeit falsely, the necessary key to getting medical care. People with insurance frequently cannot get care, and most uninsured do get care because of EMTALA’s (Emergency Medical Transport and Labor Act of 1986) unfunded mandate.
The benefits or medical care provided by insurance is at the discretion of the insurer rather than chosen by the patient with advice from the doctor. Denials of needed care are common. Wait times to see a physician are dangerously long, with an average maximum of more than 132 days. Death by queue has been documented in both Medicaid and Tricare patients — they are dying while waiting in line (a queue) for technically possible care that is not provided in time to save them.
Health care (two words) is an intimate, confidential service contract between one patient (buyer) and one physician (seller) to provide medical care in exchange for compensation. Medical autonomy — a patient’s right to choose — is a fundamental, supposedly legally protected element of the patient-doctor fiduciary relationship.
The U.S. healthcare system is a parasite that consumes 31 percent to more than 5o percent of all U.S. “healthcare” spending, taking $1.5 trillion to more than $2.4 trillion worth of care away from the American people. People want that money to pay for medical care, not to pay bureaucrat-MDs like Fauci, the highest paid federal employee of all, paid more than the president.
The Affordable Care Act (ACA) was one example among many of such “bureaucratic diversions.” President Obama took $716 billion from the Medicare Trust to pay for ACA infrastructure, code for BURRDEN — Bureaucracy, Unnecessary Rules and Regulations, Directives, Enforcement, and Noncompliance activities such as oversight and review. That money could no longer be allocated to pay for future hospital care for seniors. According to the Trustees, Medicare will be insolvent by 2036.
The U.S. healthcare system is financed through a third-party (insurance) payment structure. Those enrolled in Medicaid, Medicare, Tricare, and healthcare.gov — 157 million Americans — are subsidized by Washington using taxpayer funds. The 147 million with employer-supported health insurance are indirectly subsidizing the system as the “support” that employers divert to insurance companies is compensation that rightfully belongs to employees but is denied to them based on obsolete World War II wage freezes.
What could happen if Trump and Congress, possibly following advice from DOGE, would “take away healthcare,” meaning radically reduce healthcare BURRDEN? Suddenly, medical care could become affordable, timely, quality, and compassionate. 157 million workers would get a raise of $23,968 to spend as they choose. Hopefully, they would put the money in a new, deregulated and therefore unlimited, bank account called a tax-advantaged CSA (Care Spending Account). They could shop and spend their own money for both care and insurance. Sellers of both care and insurance would have to compete for consumers’ (buyers’, patients’) dollars. This would infuse free market forces into healthcare driving prices down and elevating service. With Washington no longer in charge, the doctor shortage would begin to resolve.
Wasteful spending on BURRDEN would drop dramatically, potentially releasing more than $1,500,000,000,000 to use productively for care and/or to return to taxpayers. (Pay attention, DOGE!)
Medicaid and the ACA would be replaced by block grants to the states for state-designed and state-operated medical safety nets. This would further reduce federal spending, improve predictability of federal as well as state budgeting, eliminate a powerful incentive to spend, and improve access to care for the medically vulnerable.
Looks like “taking away healthcare” would be very good for the health of Americans.
Deane Waldman, M.D., MBA is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of Center for Healthcare Policy at Texas Public Policy Foundation; former Director of New Mexico Health Insurance Exchange; and author of 12 books, including multi-award winning, Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine. Follow him on X.com @DrDeaneW or contact via www.deanewaldman.com or Contact him at www.deanewaldman.com.
image, Pixabay license.
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