In an odd sense of timing, Jeb Bush, former Republican governor of Florida, released his plan for overhauling Obamacare on the same day as the first debate for the Democrat Presidential candidates, so there was little media attention to his proposals. Governor Bush’s plan does address some of the worst provisions of Obamacare and pushes for a more limited role of the federal government. But it’s still a very mixed bag.
On the plus side, the Bush plan lacks the massive micromanage-ment of Obamacare. It would give states more flexibility to decide how best to use a pool of money from federal taxpayers to provide medical coverage for those with low income and/or pre-existing conditions. But each state would still have to meet federal criteria on various outcome measures, yet to be determined. This is a “tweak” but not a “fix” for a serious flaw of Obamacare.
Bush proposes an overhaul of the Food and Drug Administration (FDA) that is long overdue and badly needed. As he stated, “It should not cost $1.2 billion to $2.6 billion nor take 12 to 15 years to advance a medicine from discovery to patients, but that is the case under the Food and Drug Administration’s current regulatory mess.” In my field of medical practice, American women were denied FDA approval of Estrogel, a bioidentical estradiol gel for menopause therapy, for 30 years after it was approved in France and widely used around the world.
Another plus is that Bush proposes to end the inequality in tax treatment of employer-sponsored health insurance plans, which are free of both income and payroll taxes, and individually purchased policies, which are not tax-deductible, and must be purchased with after-tax dollars. In other words, owning your own policy absorbs up to twice as much of your earnings as an employer-owned policy. This inequity leads to “job lock”—people are dependent on their employer for affordable health coverage. Your employer doesn’t own you, but he may own your health insurance!
The Bush plan, however, like many other supposedly conservative plans, uses the idea of a “refundable tax credit” to help pay for health insurance. If the amount is greater than taxes you owe, it is an outright subsidy, a transfer from other taxpayers’ earnings to health insurance companies. In other words, it is a wealth redistribution scheme that distorts the market by prepaying for other people’s “healthcare” (which means their medical care plus a generous cut to its managers and payers).
Fundamentally, Jeb’s plan suffers from several fatal flaws common to many proposals:
• The idea that government should be involved at all in regulating and overseeing medical care. Government-mandated coverage and onerous regulations are at the root of the massive cost increases in health insurance premiums under Obamacare.
• The idea that funds should be redistributed from Medicare serving the elderly to pay for the expansion of Medicaid for younger people. Obamacare’s redistribution of medical service funds takes money from sick older patients needing cancer treatment, joint replacement, hospital readmissions for relapses of heart or lung disease, hospice, and home health care of the sick to instead provide “free” abortion, contraception, and preventive screenings to younger, healthier people. Bush is apparently silent on the more than $700 billion Obamacare cut from Medicare to spend on more politically favored younger groups and their lifestyle choices.
• The idea that Obamacare can be “tweaked” rather than repealed in its entirety. To date, Senator Ted Cruz is the only Presidential candidate of either party to call for total repeal of Obamacare, not just “tweaking.”
Obamacare is a “bomb” about to destroy the world’s best medical services. It is already causing health insurance premiums to explode, and causing massive damage to the economy with its job-killing mandates on employers. You wouldn’t want the bomb squad to “tweak” a bomb that is under your house, as Bush proposes. It is time for this bomb to be dismantled and removed completely as Senator Ted Cruz proposes, before more damage is done.
We need a candidate who sees clearly the harm that Obamacare is doing to individuals, medical practices, patient services, and the economy. We need to repeal Obamacare’s whole tangled structure and start over, with market-based, patient-centered solutions. We need to end the idea that the federal government can “fix” quality or cost by overseeing and interfering in medical decisions. The power to make those decisions belongs in the hands of patients, in consultation with their chosen physicians.
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Elizabeth Lee Vliet, M.D. is Past Director of the Association Of American Physicians and Surgeons. She is a preventive and climacteric medicine specialist with medical practices in Tucson AZ and Dallas TX that take an integrated approach to evaluation and treatment of women and men with complex medical and hormonal problems. Dr. Vliet is also President of International Health Strategies, Ltd., whose mission is twofold: liberty and privacy in treatment options and preservation of the Oath of Hippocrates focus on the individual patient.
