Donald Trump closeup
Photo by Gage Skidmore via Wikimedia Commons

As the grueling Republican primary is drawing to a close, it looks more and more like The Donald is going to be the Red candidate (unless, of course, there are some successful shenanigans at an open convention). So, it’s probably time to do a deep dive into Trump’s thinking about healthcare. And, what better place to start than his campaign website (accessed April 24, 2016) where he briefly outlines his seven proposals for reform.

 

1. Repeal Obamacare

No matter what some of our Republican friends say, The Donald is a Republican, at least when it comes to his first proposal: “Completely repeal Obamacare.” He goes on to say that “our elected representatives must eliminate the individual mandate” because “no person should be required to buy insurance unless he or she wants to.” There are so many problems with the last part of his statement that it is hard to know where to start.

First of all, except for people who are able to self-fund the treatment of serious conditions (say, advanced cancer, a heart attack, or injuries from a car crash), everyone wants health insurance when they actually need it. They just don’t want to pay for it when they are young, healthy, and, in their own minds, invincible.

Next, there are tons of people who want health insurance, but can’t afford it. Obamacare has made a dent in the number, but, in too many states, failure to expand Medicaid has left lots of lower income people in the lurch. The individual mandate means that the pool of people paying into the insurance pool is bigger and the premiums lower than if only sick people participate.

 

2. Sell health insurance across state lines

This is another Republican favorite, but with a twist. The Trump proposal adds that “as long as the plan purchased complies with state requirements,” any insurer should be able to sell their products in any state.

As far as I can tell, this is already the case. All of the large plans already sell plans in almost every state. The problem, according to proponents of this measure, is that they have to comply with state requirements, such as state mandates for coverage and rules and regulations of whatever state entity is overseeing health insurance. This, they say, drives up costs. What they want—the words that Trump’s proposal don’t suggest—is for plans to be able to sell across state lines and avoid those mandates and that regulation.

Trump goes on to say that “by allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.” As anyone who watches TV during open enrollment season knows, there is already fierce competition between insurers within the states. Despite that (or perhaps, in part, because of that), health insurance premiums continue to rise in the face of shrinking coverage and rising out-of-pocket costs.

Finally, a number of states tried the “Sell Across State Lines” experiment, but none of them were able to meet their goals—in part because no out-of-state insurers wanted to participate. The heart of the issue is that health plans need to develop a provider network (you know, doctors and hospitals) to actually deliver the healthcare to their enrollees. Just because a plan has low premiums in one state does not mean they will be successful at developing a network of providers that can deliver care at the same low prices in another. As Merrill Matthews, a scholar at the Institute for Policy Innovation explained in an August 31, 2015 article in the New York Times:

“Just because a good affordble policy is available in another state doesn’t mean that I would be able to get the network of physicians and the good prices that are available in that other state.”

 

3.  Health insurance premium deductions

It’s unclear from Trump’s website if this deduction is separate from other medical expense deductions that don’t kick in until they exceed 10% of your adjusted gross income for the year. If the former, one might wonder why have first dollar deduction of health insurance premiums and not other health care costs. If the latter, it could benefit low-income individuals who pay a significant percentage of their income on premiums.

For some reason, Trump goes on to say in the paragraph on this proposal, “We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.” Love it! Does this mean he is in favor of expanding Medicaid? This will surely endear him to the Red State governors and their legislators who are vehemently opposed (Hah!).

 

4. HSAs

Trump says HSAs should be tax-free and should be allowed to accumulate and be inherited! They should also be able to be used by any member of a family without penalty. My main issue with this is that it probably won’t contribute much to the unaffordability of healthcare, particularly if people use the dollars to “buy” healthcare they might have foregone if they didn’t have the account.

 

5. Price transparency

The Donald thinks “individuals should be able to shop to find the best prices” for health services. Yeah, I agree. But it isn’t really the way healthcare actually works. There are so many important and costly decisions that are simply not going to be made by the average consumer. Here are some examples:

  • Which hospital the ambulance will take you to when you are unconscious after a major injury
  • Which drug to choose for chemotherapy when the choice is one very expensive branded targeted drug (e.g., Tarceva) vs. older, less expensive approaches (at least in the short run) such as chemotherapy
  • How long you stay in the hospital (at $10,000 a day)

I could go on and on, but I think you get the point. Price transparency will work for some things (i.e., which of several comparable drugs should I choose or which primary care doctor should I enroll with). But an important caveat is that price transparency must be combined with quality transparency so that consumers will know what they are getting for the cheapest price?

 

6. Block-grant Medicaid to the states

According to Trump, “states can manage the administration of Medicaid far better without federal overhead.” But an important part of the overhead is oversight. Although he infers that all states are good actors when it comes to Medicaid, that simply is not the case. According to a 2014 article in the Atlantic, Mississippi, a state consistently ranked as having one of the worst healthcare systems in the country,

“Medicaid eligibility for non-disabled adults is limited to parents with incomes below 29 percent of poverty, or about $6,800 a year for a family of four, and adults without dependent children remain ineligible regardless of their income.”

Need I say more?

 

7. Free markets for drug providers

Now, this one I like: “Remove barriers to entry into free markets for drug providers that offer safe, reliable, and cheaper products.” The one caveat is that he needs to ensure there is good oversight so that only drugs that are safe and reliable are a part of the prescription drug marketplace—that would probably mean beefing up and depoliticizing the FDA. Trump goes on to say, “Congress will need the courage to step away from the special interests and do what is right for America.” Hmmm, I say Amen to that.

 

So, can DonaldCare fix the problem?

I think not. These proposals are too narrow and too focused on the free market to lead to what Trump calls for in the introduction to his health platform:

“…broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans.”

Our healthcare non-system is just too convoluted to fix it with these 7 proposals. For one thing, Trump doesn’t mention quality except in this opening statement. Only focusing on cost of care is unlikely to lead to a system that reliably delivers high-quality care—that actually takes requires a lot of work.

Further, his reliance on free market forces in an industry as lucrative as healthcare seems to ignore the powerful driver called greed. Think about it. Has any industrial sector in our country actually done the right thing without serious regulation and oversight (think banking, guys). Is that really the kind of healthcare system we want?

I believe if we are going to get a grip on healthcare we need to look outside our country to see what is actually working elsewhere, for example, the Canadian system or the UK’s NHS. Ok, I know some of you are ready to go berserk on me for bringing up single payer, but that, my friends is the subject for another blog.

Leave a comment…I would love to hear your thoughts….

52 COMMENTS

  1. The author seems to have a bias towards top down big government monopolies. Monopolies in healthcare are not the solution. We do need more competition, more price transparency, more incentives to enter the healthcare field, and less government over regulation. Healthcare has been broken a long time. Obamacare has made things worse. I don’t think Trump is a great choice for president though (not that Clinton would be any better).

  2. I would like to see Medicare adjusted to cover assisted care and nursing home care to include the middle class. Include Tricare for Life because it is only good until you have to go to one of the aforementioned situations. Not for life.
    If you have a lot of money and can self pay, you are set. If you have just a little or nothing at all, Medicaid will pay. And pay, and pay, and pay.
    If you have a modest home and a little in savings, you have to pay yourself after 20 – 100 days, during which there are all kinds of rules to put one in a self pay situation.
    The quickly dwindling middle class is the group that always gets to pay. To someone or for someone.

  3. Wow !
    You Americans sure are “United” ! I can feel the love in that great nation of yours…
    Can’t wait for America to be great again with Trump.. (By the way when was the last time America was great ? )

    René C.
    Montreal, Qc, Canada

  4. There is one way to completely “fix” healthcare….incentivize participants to engage in regular activities that improve health, like exercise and proper nutrition.

    The over riding reason US healthcare is in the ditch is because the majority of the population are land whales who take no responsibility for their own health.

    Look at yourselves. You should be ashamed. The way you treat your bodies is an offence against what God has gifted you with. You all deserve exactly what you are getting.

    To expect me to pay money to help the obese pig drinking 4 litres of pop and 3 pizzas a day is ridiculous.

  5. Insurance across state lines with competion only works if you eliminate the individual state health care mandates.
    This would make Health Insurance affordable and pay for the coverage you need rather than mandated by the state.

  6. Obamacare, and most other suggested plans are not about health care at all. They are about insurance. The governing class (the “establishment”) see that massive pool of money and cannot bear not having it to play with.

    I have an alternative suggested health reform plan. That is, we do what we were doing before Obama showed up. Anyone could walk into an emergency room and get medical care. Except that we extend that privilege to “immediate care” clinics, many of which already exist. The governments would cover the costs of these walk ins with the money we are already blowing on Obamacare. The national health service NHS, or the local governments, would institute new clinics where they are lacking.

    Further, in order to staff the government supported clinics the government would expand the National Health Service along the lines of a military oganization. There could be health professionals in this service, paid by the government, and working in the clinics on a modest salary (not civil service, but more like military service). The government would offer scholarships to pre-med & medical school for any qualified individual who would, in turn, be obligated to intern, take residency, and serve for, say, 10 years in this NHS corps. This would (slowly) increase the availability of doctors, and also provide a path up to the currently disenfranchised.

    Ordinary insurance, and Medicare supplement plans would be untouched, and take any form that sells, purchased by those who want their own doctors. I can imagine that this would be commonplace, since, being a government freebie entity, the clinic doctors would not be held in high regard.

    That would actually provide health care to those who have to depend on meager ER services now, and actually help people.

    • Mr. Durkin, Obamacare is really about Socialism, government take-over and wealth redistribution of wealth. Of course, let’s not forget keeping the Democrat party in power, since with “free” healthcare, you now have something that you “give” away to someone for “free…” The “establishment” doesn’t end up paying for recipients of Obamacare, sir, taxpayers do. The fact that you can get care at an emergency room underscores the fact that people do get treatment, and healthcare is not limited to just those who can afford it. We should never have had Obamacare in the first place, because it was built from the ground up as nothing more than lies and fraud. Did you miss the stories about Jonathan Gruber? None of the promises Obama made have come true, and the cost of Obamacare, like any other welfare program, is skyrocketing, and it will get worse. Obamacare also steals from Medicare, which is taxpayer’s money that should be left alone!!! This is simply thievery! However, you do make an excellent point with the military-style system, but you left out one very significant point—the cost of malpractice insurance. Military members are not allowed to sue their doctors, so neither should indigent patients. Your idea of schooling and residency are very good ideas, and I agree with you on that. However, I do take issue with anyone who seems to think that “anything” is “free.” We have a $19 trillion dollar national debt and growing, and over $200 trillion in unfunded liabilities with SS, Medicare and Medicaid. Simply put, there aren’t enough people contributing enough to the system.

      • Of course Obamacare is a step toward socialism. Socialism is a politically enfranchised group controlling all the wealth, to dispose as they please. Naturally, they would invest a portion of it in ensuring they have political control. But vast piles of money inevitably ensure vast corruption, and vast armies making livelihoods out of sucking some of it up.

        This is the same as it ever was. It was important, in medieval times, and before, to have a “position at court”, that way, a person would get rich. Socialism isn’t a reform, it is a regression to the way things were, where the king owned everything and everybody, and took what he wanted. Life was simpler then: you obeyed, or you killed the king, or the king killed you.

        The point of Obamacare is to transition to a single payer system, where the government really does control all that nice cash. It also provides a segue for the government to control people’s lives, as it becomes fiscally irresponsible to allow people to, for instance: smoke, drink too much pop, drink alcohol, eat red meat, eat sugary desserts, ride motorcycles, think disturbing thoughts, you name it. A liberal’s dream world: absolute societal control. A bummer thought is that this is just lately becoming technically feasible.

        Perhaps it is inevitable. A law of nature is that anything that can happen will happen. We need to be focused on resisting central government growth and control, and support that resistance in general. I hope it is possible to slow the statistical trend, although it is looking pretty bleak.

  7. Ah, that’s the solution to all our problems! We all need to be like Scott! I’m going to start by making my deadbeat brother in law fend for himself. Sure, he has Down Syndrome, but gosh darn he should just go and get an IT job and the country will turn right around.

  8. “The age of rugged individualism is over. People cannot buy houses or other necessities because salaries are too low, and unless the government receives more taxes from American, oversees industries that pay much more than minimum wage, the government will have to help families.”
    Leila Jaden–you are mistaken about individualism. Individualism is what must happen for this country to ever gain footing. This country has a $19 trillion dollar debt, and over $200 in unfunded liabilities. Nothing is free, and too many people are dependent on the people who have jobs and who contribute to the tax base. I have bought 3 houses in my lifetime, and will probably buy another before I die, and have a car and a truck, and all the things I need and then some. I married someone who also has 2 degrees, makes a good living and we manage our money. Individualism is here to stay for those who believe in themselves. The rest are dependents, and their entitlement mentality is indicative of their failures.
    Salaries have to do with the skillset and the marketability of that skillset, Leila. That is decided by YOU, not someone else, and not by government. Over-taxing industries only sends those industries offshore. What you need, Leila, is a DEGREE in a field that pays well and that will be here long-term. I am in the IT field, which will be around for many decades to come. If you have a degree or marketable job skills, companies must compete to keep your talent, and those companies are willing to pay what your skillset brings to their business. But if you only have menial skills, everybody can do that job, and it will never pay well. Forcing a company to pay high wages makes them uncompetitive, and ultimately forces them out of business, and you out of a job.
    Do not depend on government, but yourself. Do what you have to do to earn a degree in a good paying field. I have 2 degrees, and multiple IT certifications. Government has no money, Leila, and the benefits it doles out comes from other taxpayers, not from money that government has “earned.”
    Many people get by on far less than what I make, and do not demand handouts from government. The Great Depression forced everybody in the United States to depend on themselves, and people learned to get by with what they had, so they depended on themselves and family, not government.

  9. Here is what works—buy your own insurance! It works for me, except my rates keep rising from all of the folks who are dependents. (translation: kids having kids, illegals, deadbeats, chronically unemployed, etc. etc. In other words, Democrat voters…) And, when you retire, use your retirement account that you saved when you were working to pay for your insurance, or else keep working! All of the complications of healthcare arise simply from a fundamental principle—not enough money to take care of people who are not contributing to any system, (in many cases never have) much less their own private insurance. Wake up, folks! Take a look at the VA if you want to see socialized medicine! You replace profits (and greed) with corruption, inefficiency and ineptitude. Take a look at all of the veterans who have died who were on the VA’s waiting list, which somehow got “erased” or “lost” or “altered.” Then remember how many VA administrators got bonuses for all of their “good work.” If you dependent on government, you are costing the rest of us! How about this idea—don’t allow lawsuits for indigents! The military cannot sue their doctors, and they work for a living! A huge chunk of the cost of healthcare is the cost of insuring the doctors themselves against frivolous lawsuits. When an OBGYN has to spend more than $200,000 per year for malpractice, the cost for insurance and healthcare goes up. Government is not the answer to our problems, but the source of them!

    • Finally someone has brought up tort reform.
      No plan, simple or complex will not work without tort reform. Most doctors do far too many expensive test to protect their practice from lawsuits that are outragise.

  10. “…. any insurer should be able to sell their products in any state.

    As far as I can tell, this is already the case. All of the large plans already sell plans in almost every state. ”

    Dr. Salber, this is not already the case. Insurers are regulated by states, and the principal focus of insurer regulation (they basically self-regulate, and that deplorable situation is a topic for another rant…) is their solvency – their ability to pay claims.

    So, while it may appear that health insurers operate ‘freely’ across state lines, for the purpose of issuing policies any given firm operating in several states may as well be “one firm in brand/logo only” across those states.

    Maybe more to the point – cross-border sales have been tried in some states. All these initiatives have been dismal failures, ideological pipedreams. My favorite example is Georgia: no insurer even bothered to offer policies under the scheme they tried about a half-decade ago. The article at this link sums it up: http://www.ajc.com/news/news/local/no-out-of-state-insurers-offer-plans-in-georgia/nQTQg/

  11. Crossing state lines I’m afraid may not work, when you compare to auto insurance where many companies pull out of expensive areas or states.

  12. Dr. Salber, don’t try playing me for a fool. The truth of the matter of Social Security and Medicare is that it is a PONZI SCHEME! The money I put in Social Security is MY money and should go to me when I retire, instead of to some illegal immigrant or to someone on disability, or just to “someone else.” The plain and simple fact is that there is not enough money in Social Security (or especially Medicare) that will pay for an individual’s way once they retire. It is as simple as that. If you rely on Social Security and nothing else, you have not adequately planned for your retirement! It’s not up to government to take care of you, (ie. steal from someone else to redistribute to you) it is up to YOU to plan for your retirement! Socialism does not work, doctor, and SS and Medicare, once you have used up the money you paid in, are nothing more than welfare. This nation is $19 TRILLION dollars in debt, and most of it is due to these (mostly) Socialist programs and Medicaid, which is pure welfare. You simply can’t expect $300,000 out of an account (jokingly—it’s a pot of gold, not an individual account) when you only paid in $100,000. (as an example) It doesn’t take a medical doctor to understand this.

    • Drive by any Social Security Office in the New York City area, and probably a good part of the country, about 15 minutes before the office opens. Outside you will see a line of 50 to 100people waiting to get in and at least 95% of the people waiting for the doors to open are young, healthy looking individuals under 35 years old. Most are female and a large percentage of them are pushing baby carriages. When Roosevelt created that Ponzi scheme, and that’s what it is, I don’t think he could even foresee the abuse and outright fraud that was to come.

    • One of the difficulties in explaining to someone as stupid as you obviously are all of the ways in which you misunderstand reality is that you are as stupid as you obviously are. You have not gotten it, you do not get it, you will not get it. Better to simply deport you, or failing that ignore you. It would be rude to laugh at you; it’s not your fault you’re this toxically clueless.

  13. Obamacare is nothing more than welfare, and we have way too much welfare as it is. We should stop trying to think that government is the answer to our problems. The best way to keep healthcare costs affordable is to use high deductible plans that the individual pays himself, not a welfare handout. The costs of healthcare keep going up because more and more people are using the system without paying for it. Single payer is a disaster everywhere it is used, so don’t pay any attention to those folks from Socialist systems. The fact is that you can’t pay for any healthcare plan at all if you don’t have a job! The more government plans there are out there, the less a person will do to fend for himself. Hey, Socialism doesn’t work in any country where it has ever been tried! Reliance on government handouts is the major reason we have such a huge national debt! The last thing one should do is to rely on government programs to take care of us. How about standing on your own two feet and assume responsibility for yourself? I don’t go to work to pay your way!

      • Doctor, Social Security and Medicare, once you have taken out more than you have put in (plus the lousy government interest rate) is nothing more than welfare, and Medicaid is PURE welfare. It doesn’t take a medical doctor to understand Socialism. You cannot take out $300,000 from a system when you only contributed $100,000 into it and expect nothing less than bankruptcy. There is no math on Earth that will support this. When Social Security began, there were 16 workers to 1 retiree in the system. That would work as long as the ratio remained constant, but it hasn’t. It is now less than 3 workers per 1 retiree, so it simply is not working. This is no different than opening a new credit card and spending and spending, until you can’t spend any longer and the bill comes due. Now that there are so many people who are not working, (though you would never know it because we don’t count those who stop looking for work. So, this makes them “employed???”) not contributing to the system, and are only taking from the system. Too many welfare programs that have done nothing but incentivized dependency, too many people with an entitlement mentality, and a government that taxes businesses to the point of outsourcing, regulates them out of business and discourages them from starting businesses are the problem. People who work for a living can make ends meet, but those who won’t, cannot, and it is not my problem to take care of all of the bastard babies of those who are immoral, irresponsible and foolish in this world.

    • The age of rugged individualism is over. People cannot buy houses or other necessities because salaries are too low, and unless the government receives more taxes from American, oversees industries that pay much more than minimum wage, the government will have to help families.

      Insurances companies could be being greedy, I don’t know. But I do know that every company has overhead expenses, and must make a profit to stay in business. That is why I believe the US needs a single payer system. Employers and individuals who can afford healthcare can still choose to use insurance companies, but other people could not have deductibles and have their doctor visits based on their incomes.
      Now that universal healthcare is a part of the American psyche, I believe that American leaders and healthcare professionals can design an affordable system.

  14. The author of this opinion piece clearly represents the insurance companies. Everything she says is skewed in favor of the status quo. Opening all 50 states into open competition would drive down the cost of healthcare at least 25 to 30 percent.. Yet she claims it wouldn’t.. Pure propaganda. This entire article should be written off as propaganda by a corrupted healthcare system that doesn’t want change so they can continue to rob Americans.

    • Dan, I provided links to high quality articles that support my statements – can you provide any to support the statement that selling across state lines would drive down the cost of care by 25-30%. Further, can you respond to the study that looked at states that passed such legislation and either didn’t find it feasible to implement or couldn’t find any insurers that were willing to compete in that way. I am definitely not for the status quo, but I am for solutions that make sense and have a chance to work. The US healthcare non-system is very complicated – just because something sounds good at a simplistic level, doesn’t mean it would actually work. Click on the links in my article – you will see what I mean.

  15. Give everyone the same coverage the president has and add the cost into the income tax formulas. This way no one should complain about the quality of care and since everyone is given the same coverage the cost should be as cheap as it can get.

  16. The British NHS (which is the system successfully used in a number of other countries) is not merely a single payer system it is a single provider system also and it is the integration with the provision of health services that allows the control to make the system function as it should. A single payer system that relied on private health services providers is a different beast altogether. It does not mean it will not work but private tertiary health care providers but it can mean a more complex and costly service delivery. The integration of state provision of health care with a simple income related tax works well. It is never perfect but access to medical care for low income individuals and families and for the chronically ill is a state responsibility.

      • Which is partially the point. Integration of the providers of primary and tertiary health care with the funder is a proven workable strategy. On a national scale it becomes more difficult to integrate a multitude of providers and those countries that run a system like the English NHS do that through a state owned and funded single provider scheme which is funded through an income related tax or levy. The US is far more complex because of the predominance of private health care providers and insurance funding model. A hybrid model based on single funder with multiple service providers could work but I’m not there is a current working example.

        New Zealand has gone a step further and has a no fault Accident Compensation scheme which pays for accident related health costs and rehabilitation as well as providing income compensation when people are off work as a result. It is funded through an income related levy paid by both Employer and employee.

      • You are lucky, as a senior citizens, I an lucky to have a medicare advantage plan. However I don’t know why I also I have to pay for part B. Part A gives me the right to have medicare funded. In South Jersey we have very limited advantage plans. The major medical insurers have convinced the 65+ age population that they need to have gap insurance, Medicare A&B, and supplimental ins. and Part D coverage. Hospitals, medical services are not the only ones gouging us, More info needs to be given out to everyone by mail. Not every senior has a computer.

      • I would argue that Kaiser work well. This comment can only be made when taken in the US context and ignoring other successful models globally. As an example. The month I switched jobs, with no break in employment, and both covered by KP, I was not covered by KP. It was also the month I needed their services. After a simple visit to the doctor cost me over $400, plus a $125 up front payment, instead of the regular $25. When I queried this by phone I was given an option: take an 80% “discount” on the $400 outstanding there and then, or contest it through other channels. Of course I took the 80% “discount”. But it begs the question: there is no ways KP made a loss on me even at 80% discount. So who typically pays the for the full coverage? The tax payer. And who benefits, and to what purpose? KP, for investing into their not-profit real estate portfolio. It thus appears KP are following the Catholic Church business model. Under the guise of health care, they are actually amassing wealth through property holdings at the tax-payers expense. And then we hold them up as a model insurer? I think not.

        Having lived in and experienced the Australian two-tier system, the US could do well by opening its eyes (and mind) to other successful models. Very good basic health care is free, a Medicare for all (there is a flat 1% levy on ALL incomes with NO tax breaks for the wealthy which funds the scheme). Generic drugs are offered where possible, not high profit margin proprietary drugs. The system is designed by and run by the government, focusing on the patient and not on the profits of shareholders of the drug companies. Even so, Australia is at the forefront of medical research, so the argument that only profit (or greed) drives the industry is not valid.

        The individual may then opt-in for the second tier which offers private coverage for a wider range of services such as chiropractic. Even at the maximum coverage, I was only paying $136/month and getting excellent service.

        People, please research other successful countries and then put pressure on the pure capitalistic greed of the US so-called health industry. Profits should not come before people in such an industry. In the world’s richest nation, it is a travesty that we are not taking care of our neediest.

      • Kaiser will work well in populated areas. However, you surely know that Kaiser is very strict on Zip Codes of those who can enroll. The reason for this is not that they are “mean”, but rather, it is necessary for their type of system to work. It will not work in less populated areas.

  17. Government needs to force hospitals, doctors, and drug companies to lower their prices so that insurance isnt necessary.

    • Then they can force automakers to lower their prices so I don’t have to take out a loan to buy a new car. In no time time at all the country will have no cars. We won’t have any doctors either.

      • Companies can still profit without making their customers go broke. Cars can be expensive to make, so the cost is reasonable in comparison to healthcare. Loans are optional; health insurance under obamacare is required. Doctors charge a large sum even for a simple checkup, and even if they have no idea how to cure the patient’s illness/ailment, or even how to diagnose it. Some prescriptions are very expensive despite costing very little to make. Forcing people to get health insurance only continues to encourage doctors/hospitals/pharma companies to overcharge patients because they know insurance will foot much of the bill. If you think you have a better solution than what i proposed, say it.

  18. If you don’t adopt a single payer system (with or without a degree of member copayment) you’ve been out in the sun too long and smoking some kind of weed. 100 million people or more, negotiating as one must surely have more market clout than 100 million individuals.

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