Health care is one of the most ideologically divisive issues in the country, with wide ranging implications affecting not only the health care industry (providers, employees, beneficiary industries) itself, but the average Americans in general, as well as the government (both at local and federal level), along with the national economy, owing to its sheer size.
This very complex subject unfortunately has been reduced to two chief fundamentals, namely, the mechanics of cost and the scope of coverage.
There are two major schools of thoughts dominating the mainstream thought process when it comes to the American health care system.
The first school of thought (primarily in the conservative sphere) believes that the federal government's involvement in health care should be similar to every other sector of the economy - minimal. The healthcare industry should be left to its own devices, and allowed to achieve a point of maximum efficiency through a system of trial and error based on our own unique blend of free market economics- the very same organic process that successfully propelled the American economy to become the largest in the world. The health care industry must learn to navigate itself through the vicissitudes of the open market, without the comfort of a federal safety net blunting its competitiveness and natural ability to evolve. Case to the point: this process of trial and error has already exposed the impracticability and harmful effects of a federal or state mandate on health care economics, which almost always result in insurance firms building additional cost into their premiums.
The second school of thought (primarily within the liberal sphere), on the other hand, believe that health care is not a business. It is the fundamental right of every member of our society to have access to health care. By subjectively abdicating the responsibility of managing the national health care, and handing the task to the fragmented, uncoordinated and capitalistic private enterprises, we are risking the health and well-being of millions of Americans. Private firms, by its very nature, are chiefly answerable to their shareholders, and thus, will attempt to minimize its business risks and increase its return of investments by excluding the weakest and least commercially viable members of the society from health care coverage. The aged, the poor, the chronically ill and the high risk demographics will inevitably be left in the sideline as insurance companies and private healthcare providers pursue their overarching strategic goals. Furthermore, the United States is one of the last remaining developed country that has yet to implement a universal healthcare system. This is despite the fact that the United States spends more on health care per capita ($8,937) than any other developed countries. 29 of the top 31 developed countries in the world has a universal health care system (twelve single payer, nine two tier, and eight insurance mandate).
The exponentially accelerating cost of health care has been a major source of concern for successive American administrations since the Nixon presidency.
In fact, there have been numerous health care proposals flying around the Capitol over the last four decades; nonetheless, there have been only incremental reforms and tweaks enacted thus far.
However, on March 23, 2010, President Barack Obama's controversial H.R. 3590Patient Protection and Affordable Care Act (Full Text), referred to by many as Obamacare, was signed into law. It is the most transformative piece of legislation passed by Congress since the enactment of the Medicare Legislation of 1965.
Mandate for businesses (exception applies) and individuals to have an approved level of health insurance, enforceable by penalties
A federal subsidy program to pay, either in part or full, the health insurance of 34 million uninsured American to comply with item 1.
Prohibition for insurance providers to deny coverage based on preexisting conditions, a move which is expected to extend coverage to an additional 20% to 66% of the U.S. adult population, approximately 36 to 122 million Americans (Source: Government Accountability Office, Estimates of Individuals with Pre-Existing Conditions Range from 36 Million to 122 Million, March 27, 2012)
A range of regulatory changes related to the Patient Centered Outcomes Research Institute (PCORI) and the Independent Payment Advisory Board (IPAB), including discounts on physicians reimbursement claims
Health insurance exchanges
Expanded access to Medicaid
Staggered rollout beginning from June 12, 2010, to 2018
The creation of mandates for businesses and individuals, as well as the introduction of a range of new regulations, expands the federal government's role in health care into unhealthy levels and encroaches on the personal liberty of individuals
The creation of a federalized subsidy system, through a mixture of health insurance exchanges and Medicaid expansion to enable uninsured Americans to comply with the federal health mandate
Penalizing healthier and younger insurance policy holders with higher premiums to subsidize uninsured Americans
No real efforts to tackle the spiraling cost of health care
Questionable figures used to calculate the PPACA's actual cost, with some claiming that it will actually increase health care costs by a significant margin
The coverage is not universal, and as many as 20 million Americans are expected to remain uninsured upon the plan's full enactment
Gov. Johnson believes that a bloated legislative and regulatory environment is depriving our healthcare system of the ‘competition factor’, leading to inefficient government-sanctioned monopolies.
He considers President Obama’s Patient Protection and Affordable Care Act of 2010 as unconstitutional and intends to repeal it, along with former president George W. Bush’s Medicare prescription program.
A Johnson presidency would see an immediate 43% cut on federal Medicare and Medicaid funding, with the remaining amount redirected wholly to the states, no strings attached.
Johnson believes health care should be left to the states, and allowed to grow in a free market environment. "I’m promising to submit a balanced budget to Congress in the year 2013 that will detail a 43% reduction in Medicaid and Medicare. Before anybody falls of their chair, with regard to a 43% reduction in either of those categories, it’s important to point out that if we don’t balance the federal budget, we’re gonna find ourselves without any health care at all.
So as Governor of New Mexico, I oversaw the reform of Medicaid in New Mexico. Health care to the poor - changed it from a fee for services model to a managed care model, set up better health care network, saves hundreds of millions of dollars.
I believe that at the time, if the federal government would, were to have block granted the state of New Mexico 43% less money, done away with all the strings and mandates, that I could’ve effectively overseen the delivery of health care to the poor in New Mexico. I think the same model applies to Medicare. Fifty laboratories of innovation and best practice. The federal government has to give it up to the states."
Apr 28, 2012: Johnson speaking at the Fort Worth Libertarian Party of Texas Presidential Debate
"You got to start out by talking about Medicare and Medicaid. I'll just throw out some suggestions here. There are other, but let me just throw the fact that the federal government could cut Medicaid and Medicare by 43 percent…
… They could block grant the states. I'm going to say this throughout my campaign, 50 laboratories of innovation, the notion of best practices. Give it to the states to deliver health care to the poor and those over 65 and do away with the strings. Do away with that regulations - Let states handle it. There would be best practices emerge. Other states would emulate the best practices. They'd be failure. States would avoid the failure.
In New Mexico, Medicaid, now it came with all the strings attached. It came with all the regulation attached. It came with a mandate that here are the services that you had to deliver, but Medicaid in the State of Mexico, I shifted that from a fee for service model to a managed care model and saved 25 percent. If I were to have been given Medicare, I could have done the same thing with Medicare and saved 25 percent. By the way, I used 25 percent. I could have saved more money. I still could have delivered health care to those truly in need by cutting it 43 percent, I could have done that. But I was governor of the state. I had a legislature that was 2/3 Democrat and, you know, I wasn't the benevolent dictator."
May 27, 2011: Johnson on Hannity' Primary
Johnson: Specifically, and this is waving the magic wand, because I recognize that there are three branches of government, I would have the federal government cut Medicare and Medicaid by 43 percent and block grant the programs [to the states] with no strings. Instead of giving the states one dollar—and it’s not really giving because there are strings attached—the federal government needs to give the states 57 cents, take away the strings and give the states carte blanche for how to give health care to the poor. I reformed Medicaid as governor of New Mexico and, in that context, even with strings attached, I believe I could have delivered health care to the poor. I believe I could have done the same thing with Medicare…
Holleran: Will you issue an executive order to repeal Obamacare as unconstitutional?
Johnson: Yes, if it’s possible. I would do the same for [President Bush’s Medicare] prescription [drug subsidies]. Two parties can take responsibility for where we’re at right now.
Aug 21, 2011: Interview with Gary Johnson, scottholleran.com
Health care was one of the centerpieces of President Obama’s 2008 campaign, and with the backing of a Democrat-dominated Congress, his landmark Patient Protection and Affordable Care Act of 2010 was signed into law after a hard-fought battle with Republican legislators. The Act introduced comprehensive reforms on national health care legislations and will eventually expand coverage to 32 million uninsured Americans. The Obama-Biden Plan
On health care reform, the American people are too often offered two extremes -- government-run health care with higher taxes or letting the insurance companies operate without rules. Barack Obama and Joe Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference.
The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors, and plans. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.
Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year. If you don’t have health insurance, you will have a choice of new, affordable health insurance options.
The Office of the President Elect, Change.gov; The Obama-Biden Transition Team
“Today, after almost a century of trying; today, after over a year of debate; today, after all the votes have been tallied –- health insurance reform becomes law in the United States of America. Today.
It is fitting that Congress passed this historic legislation this week. For as we mark the turning of spring, we also mark a new season in America. In a few moments, when I sign this bill, all of the overheated rhetoric over reform will finally confront the reality of reform.
And while the Senate still has a last round of improvements to make on this historic legislation -- and these are improvements I’m confident they will make swiftly - the bill I’m signing will set in motion reforms that generations of Americans have fought for, and marched for, and hungered to see.
It will take four years to implement fully many of these reforms, because we need to implement them responsibly. We need to get this right. But a host of desperately needed reforms will take effect right away.
This year, we’ll start offering tax credits to about 4 million small businessmen and women to help them cover the cost of insurance for their employees. That happens this year.
This year, tens of thousands of uninsured Americans with preexisting conditions, the parents of children who have a preexisting condition, will finally be able to purchase the coverage they need. That happens this year.
This year, insurance companies will no longer be able to drop people’s coverage when they get sick. They won’t be able to place lifetime limits or restrictive annual limits on the amount of care they can receive.
This year, all new insurance plans will be required to offer free preventive care. And this year, young adults will be able to stay on their parents’ policies until they’re 26 years old. That happens this year.
And this year, seniors who fall in the coverage gap known as the doughnut hole will start getting some help. They’ll receive $250 to help pay for prescriptions, and that will, over time, fill in the doughnut hole. And I want seniors to know, despite what some have said, these reforms will not cut your guaranteed benefits. In fact, under this law, Americans on Medicare will receive free preventive care without co-payments or deductibles. That begins this year.
Once this reform is implemented, health insurance exchanges will be created, a competitive marketplace where uninsured people and small businesses will finally be able to purchase affordable, quality insurance. They will be able to be part of a big pool and get the same good deal that members of Congress get. That’s what’s going to happen under this reform.
And when this exchange is up and running, millions of people will get tax breaks to help them afford coverage, which represents the largest middle-class tax cut for health care in history. That's what this reform is about.
This legislation will also lower costs for families and for businesses and for the federal government, reducing our deficit by over $1 trillion in the next two decades. It is paid for. It is fiscally responsible. And it will help lift a decades-long drag on our economy. That's part of what all of you together worked on and made happen.
That our generation is able to succeed in passing this reform is a testament to the persistence –- and the character -– of the American people, who championed this cause; who mobilized; who organized; who believed that people who love this country can change it.
It’s also a testament to the historic leadership -– and uncommon courage –- of the men and women of the United States Congress, who’ve taken their lumps during this difficult debate.”
March 23, 2010: Remarks by President Obama at the signing of the Health Insurance Reform Bill
Healthcare is a very tricky and awkward issue for Governor Romney. On one hand, he has repeatedly declared that a Romney presidency would signal the immediate dismantling of President Barack Obama’s Patient Protection and Affordable Care Act of 2010 (Obamacare). On the other hand, thanks to the Romney’s line-up of challengers for the Republican nomination and the season-spanning 20 presidential debates, almost every politically aware Americans are convinced that Romney’s own health care legislation in Massachusetts is the progenitor of Obama’s health-care plan.
Romney has been at pains to point out that the Massachusetts health care reform that he actively pushed for - alongside the late Senator Edward Kennedy - and subsequently signed into law as Governor of Massachusetts, was a state-level solution for a state-level problem - and in no way does it endorse a federal health care mandate.
Further, Romney contends that his veto of the legislation’s penalty clause, among others, was overridden by the state legislature. However, detractors argue that Romney’s attempt was made well after the finer details of the legislation had been finalized and agreed upon by both the state Republican and Democratic legislators, and was nothing more than a symbolic pandering attempt.
In addition, Romney’s critics from within the conservative circles point to several anecdotal and statistical data that show rising premium levels in the state as a result of Massachusetts’ universal health-care plan. The increased regulatory red tape stemming from the introduction of the new Health Care Connector into the buying process has also been widely criticized.
Another issue that has been gnawing at Romney’s campaign is the lack of an alternative health plan, beyond sporadic campaign rhetoric. Romney, however, has indicated that he will be unveiling his health-care plan before the presidential debate in October.
Essentially though, Romney is a supporter of universal health care. However, he wants to delegate its implementation to state level. He is against financial penalties for those who fail to comply with mandates. And similar to the Ryan plan, Romney proposes to divert money from Medicaid and other federal source of funding to the states.
Nonetheless, Romney clouded his position on the issue during an interview with David Gregory on NBC’s Meet The Press in September 2012 by stating that he is “not getting rid of all of health care reform” and intends to keep several aspects of it, namely, coverage for Americans with pre-existing conditions and extended family policies for adult children.
I want to thank the many, many people in this room who are critical in crafting and (unintelligible) the bold health care initiative that I’m about to sign. There are a lot of parents for this initiative, as you know, and I’m gonna mention a few by name, and just a tiny part of their contributions…… Senator Kennedy, together we pitched the secretaries on our vision to insure all our citizens and on the need for federal support to make the vision real. His work in Washington and behind the scenes on Beacon Hill was absolutely essential…… It’s now my pleasure to introduce my collaborator and friend, Senator Edward Kennedy. Senator…
April 12, 2006: Romney speaking at the signing of the Massachusetts health care reform bill in Faneuil Hall, Boston, Massachusetts.
Baier: About your book, you talk about Massachusetts healthcare, and we've heard you many times, in the debates and interviews, talk about how it is different in your mind than the president's healthcare law, Obamacare. The question is, do you still support the idea of a mandate? Do you believe that that was the right thing for Massachusetts? Do you think a mandate, mandating people to buy insurance, is the right tool?
Romney: Bret, I don't know how many hundred times I've said this too. This is an unusual interview. All right. Let's do it again.
Absolutely. What we did in Massachusetts was right for Massachusetts. I've said that time and time again, that people of the state continue to support it by about 3-1, but it's also designed for Massachusetts, not for the nation, and at the time our bill was passed, and that was brought forward as an issue, there were people who said, is this something you'd like to have the entire nation do? I said no. This is not a federal plan, it's a state plan. And under the constitution, states should be able to craft their own plans…
Baier: So, Governor, you did say on camera and other places that, at times, you thought it would be a model for the nation.
Romney: You're wrong, Bret.
Baier: No, no. There's tape…
Romney: No, the tape out there, continue to read the tape, and the tape goes on to say, ‘for each state to be able to look at’. I was asked time and again, in the last debates. Look back at the 2008 campaign, on the stage, I was asked at the debate ‘is your Massachusetts plan something you would have the nation do as a federal plan?’
Each time said no, the answer is no.
When you write a book, you have the ability to put down your entire view. And I put in that book as clearly as I possibly could, that the plan we did in Massachusetts had many features that I thought should be adopted by the states. I thought there were very good ideas in there. They could be a model for the entire… states
Baier: nation? You think that you are well positioned to go up against President Obama on the issue of health care?
Romney: Of course! The best, the best equipped. The best equipped. I understand healthcare. Spent a good portion of my career working in healthcare. I came out with a plan, unlike his, that doesn’t cost a trillion dollars. Unlike his, we didn’t raise taxes. Unlike his, I didn’t cut Medicare by half a trillion dollars. Unlike his, my plan’s constitutional. So what I did, worked for our state in the way the Constitution intends, which is states crafting plan that worked for their states – not a federal one size fits all plan…
November 29, 2011: Romney in an interview with Bret Baier on Fox News
David Gregory: A couple of specific areas on health care. You say that you would rescind the president's health care plan on day one. Does that mean that you're prepared to say to Americans, young adults, and those with pre-existing conditions, that they would no longer be guaranteed health care?
Gov. Romney: Well, of course not. I'd say we're going to replace Obamacare, and I'm replacing it with my own plan. And you know, even in Massachusetts, where I was governor, our plan there, deals with pre-existing conditions, and with young people.
Gregory: So you'd keep that as part of the federal plan?
Gov. Romney: Well, I'm not getting rid of all of health care reform, of course. There are a number of things that I like in health care reform that I'm gonna put in place. One is to make sure that those with pre-existing conditions can get coverage. Two is to assure that the marketplace allows for individuals to have policies that cover their family, their family up to whatever age they might like. I also want individuals to be able to buy insurance, health insurance, on their own as opposed to only being able to get it on a tax advantage basis through their company.
Gregory: Well that brings us to Medicare, because one of the things you believed in was the idea of premium support or a voucher for seniors under Medicare is to achieve the goal of solvency. Direct question: if competitive bidding in Medicare fails to bring down prices, you have a choice of either passing that cost on to seniors, or blowing up the deficit. What would you do?
Gov. Romney: Well, let's stand back, first. There's nothing about seniors in our plan…
Gregory: You'd wait ten years to implement any plan?
Gov. Romney: … because there's no change for anyone who is retired or nearing retirement. It's only dealing with people in their 30s, 20s, 40s, and early 50s. That's the group we're dealing with and saying what's the best deal for them? It strikes me the best deal for them is to either buy current Medicare or to have a private plan. A lot like Medicare advantage today. I like Medicare advantage.
Gregory: That didn't drive down prices, governor.
Gov. Romney: Oh, it sure did. Actually what, what you're saying with Medicare today was Medicare part "D" the prescription drug benefit, is that congress, in putting this together, said look we're gonna allow companies to compete for a package of prescription drug benefits, and the cost that they've come up with is far less than anyone predicted. Competition, look competition works.
“His plan is not the plan I’ll put forward, I have my own plan… I’ll be putting that out before I debate President Obama."
Jun 2, 2011 : Interview with ABC News’ John Berman “Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced.”
April 11, 2006: Op-ed for The Wall Street Journal “Free enterprise is the way America works… We need to apply that to health care… Regardless of what they do, it’s going to be after the next president to either repeal and replace or replace Obamacare - and I intend to do both.”
June 12, 2012: Romney speaking to a group of small business owners in the warehouse of Con Air Industries, in Orlando, Florida. Step 1: Give states the responsibility, flexibility and resources to care for citizens who are poor, uninsured or chronically ill. This reform speaks to the central advantage of our federalist system — that different states will experiment with and settle on the solutions that suit their residents best. Some states might pass a plan like the one we did in Massachusetts, while others will choose an altogether different route. We can empower states to expand health care access to low-income Americans by block-granting funds for Medicaid and the uninsured. My reforms also offer the states resources to help the chronically ill — both to improve their access to care and to improve the functioning of insurance markets for others.
Step 2: Reform the tax code to promote the individual ownership of health insurance. The tax code offers open-ended subsidies for the purchase of insurance through employers. This subsidy is unfair — as it doesn't apply to insurance purchased on one's own. I propose to give individuals a choice between the current system and a tax deduction to buy insurance on their own. This simple change creates the best of both worlds. Absolutely nothing will change for those who like their current coverage. And individuals who don't get coverage through their employers will have portable, lower-cost options.
Step 3: Focus federal regulation of health care on making markets work. This means both correcting common failures in insurance markets as well as eliminating counterproductive federal rules. For example, individuals who are continuously covered for a specified period of time may not be denied access to insurance because of pre-existing conditions. And individuals should be allowed to purchase insurance across state lines, free from costly state benefit requirements. Finally, individuals and small businesses should be allowed to form purchasing pools to lower insurance costs and improve choice.
Step 4: Reform medical liability. We should cap non-economic damages in medical malpractice litigation. The federal government would also provide innovation grants to states for reforms, such as alternative dispute resolution or health care courts.
Step 5: Make health care more like a consumer market and less like a government program. This can be done by strengthening health savings accounts that help consumers save for health expenses and choose cost-effective insurance. For example, we should eliminate the minimum deductible requirement for HSAs. The market reforms I am proposing will drive down costs, better inform consumers and improve the quality of health care in our nation.
May 11, 2011: Romney’s Op-Ed with USA Today, As first act, out with ObamaCare Mitt's Plan
On his first day in office, Mitt Romney will issue an executive order that paves the way for the federal government to issue Obamacare waivers to all fifty states. He will then work with Congress to repeal the full legislation as quickly as possible. In place of Obamacare, Mitt will pursue policies that give each state the power to craft a health care reform plan that is best for its own citizens. The federal government’s role will be to help markets work by creating a level playing field for competition.
Restore State Leadership and Flexibility
•Block grant Medicaid and other payments to states
•Limit federal standards and requirements on both private insurance and Medicaid coverage
•Ensure flexibility to help the uninsured, including public-private partnerships, exchanges, and subsidies
•Ensure flexibility to help the chronically ill, including high-risk pools, reinsurance, and risk adjustment
•Offer innovation grants to explore non-litigation alternatives to dispute resolution
Promote Free Markets and Fair Competition
•Cap non-economic damages in medical malpractice lawsuits
•Empower individuals and small businesses to form purchasing pools
•Prevent discrimination against individuals with pre-existing conditions who maintain continuous coverage
•Facilitate IT interoperability
Empower Consumer Choice
•End tax discrimination against the individual purchase of insurance
•Allow consumers to purchase insurance across state lines
•Unshackle HSAs by allowing funds to be used for insurance premiums
•Promote "co-insurance" products
•Promote alternatives to "fee for service"
•Encourage "Consumer Reports"-type ratings of alternative insurance plans