Donald Trump’s New Vision for U.S. Health Care

President Donald Trump spoke at about his new vision at VA Sothern Nevada Healthcare System in LA on September 21, 2018.

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Why you cannot talk to your medical provider on phone or by email? Why your medical provider cannot consult or examine you in your home using an app? Why physicians at our hospitals are not using tele-medicine, especially for patients who reside in remote areas? 

Well, they cannot because the normal medical marketplace is suppressed by our unwise government policies. And, that is just the beginning. The most serious problems in the medical marketplace are usually due to poorly conceived public policies.

Over years, the U.S. health economics is subjugated by the notion that private sector medicine has a few flaws, which must be corrected by our government.

The Trump administration has produced a surprisingly bold document: ‘Reforming America’s Healthcare System Through Choice and Competition.’

This is probably the first time the U.S. administration has explicitly recognized and accepted that the most serious issues in health economics are caused not because of the market failure, but because of the government failure.

Also, it is the first time the federal government has taken action and committed to the notion of rescuing the medical marketplace.

The Trump administration is carrying out a lot through executive authority, although cooperation from the Congress and the state governments is essential and desirable.

In all professions apart from medicine, such as law, engineering, accounting, architecture, etc., providers repackage and re-price what they offer to the market. If the technology, demand, or economy changes, other professionals change the services and the prices. Physicians have become slaves to the third-party payer system, which has been molded by our government.

Most problems start with Medicare that pays physicians today in the same way it paid in the last century. Also, private insurers and employers pay the same way. Sometimes, physicians encounter their patients on phone or by email or Skype illicitly. They cannot freely practice across state lines.

Medicare, after years of resistance, will now pay for telemedical services to remote or rural areas. However, it will not pay for the telemedical services in urban areas. This means if Medicare has to pay the bill, a patient recovering from hip replacement at home should get out of bed, travel to the hospital, get examined, and then reverse that whole process. In short, the patient must go through that agony just for an examination, which could be done at home via telemedical service.

Health Savings Accounts (HSAs) and Health Reimbursement Arrangements (HRAs) have been a great step in the right direction. However, the regulation of these accounts has been quite limiting.

Some of the problems include:

State certificate-of-need laws are averting new hospitals and other health care facilities from entering the medical market and competing with the existing ones.

The Federal Law is not allowing physicians from opening specialty hospitals.

Since Medicare and Medicaid pay more for physician services offered at hospitals than the same services offered in a private office, many physicians are becoming employees of the hospital.

If the U.S. health care functioned normally, there would have been centers of medical excellence for heart care, diabetes, cancer, and other chronic medical conditions. Patients, on the other hand, would manage their own accounts, reaping the benefits from the competitive provision of health care services. Also, they would be able to use their money for other purposes if the health care cost is reduced.

So, the only obstacle is the unwise public policy.