 TRUMP HEALTHCARE V. BIDEN HEALTHCARE. WHICH IS BETTER AND WHY?
by Julio Gonzalez, M.D., J.D. One of the central points of contention in the 2020 campaign for President of the United States is each camp's view on healthcare and which would be better for America and her posterity. Well, thefederalistpages.com has amassed a comprehensive review of both plans and offers a comparison of each with my vision for our nation's healthcare. Here's what we found. OVERARCHING PHILOSOPHY. The starting point for any discussion on healthcare is the overarching opinion on what healthcare should look like in America and how such a view would affect American society. If the starting points are starkly different, then practically everything else flows into diverging paths. In the cases of former Vice President Joe Biden and President Donald Trump, the starting premises could scarcely be more dissimilar. Biden For Biden, the starting point is centralization. Biden believes that concentrating policymaking, control, and financing into one place (the federal government) is to be pursued. As such, for Biden and his followers, placing more power in the hands of the federal government is a plus. Strengthening Obamacare, expanding Medicaid, minimizing the influence of the private sector, and having Medicare play a larger scope in healthcare delivery are all priorities. As we shall see, all of Biden's proposals line up with that view. Trump The Trump viewpoint favors decentralization. The Trump vision for healthcare places a greater degree of control on free-market forces and the various states in the hopes of increasing the autonomy of the physician-patient relationship. However, the President's plan allows for some degree government interference with free-market forces. In his plan, for example, there is ample room for consumer protection and price controls. Gonzalez The Gonzalez plan, as elucidated in The Case for Free Market Healthcare, relies primarily on the free-market to maintain stability and predictability in delivery and cost. It aims not just to place the lion's share of healthcare delivery in the hands of the private sector, but it also maintains that only the free-market is capable of identifying the most streamlined and efficient manner through which such care can be delivered. Government's footprint must therefore be minimized and the patient should be placed at the helm of cost containment and optimal price determination. PUBLIC HEALTH INSURANCE OPTION. The public health insurance is a government run entity that delivers a lower-priced alternative to regular insurance policies. By providing a public health insurance option, Americans who cannot afford private healthcare insurance or desire to obtain a lower price will have access to purchase lower cost insurance plans through a government-administered alternative partially subsidized by tax dollars. Biden The Biden camp favors and actively proposes a public health insurance option. Trump President Trump opposes a public health insurance option. Gonzalez Like President Trump, I vehemently oppose a public health insurance option. In my view this is the quintessential Trojan horse for healthcare. By seeking the advantages of government to favorably compete against the private insurance sector, the public health insurance option will necessarily and overwhelmingly expand, not due to its superiority but because of greater survivability due to undue administrative and financial support from taxpayers. If America bites into this poison apple, it will definitely be placed on the road to universal healthcare and prodigious government control of our lives. Additionally, accepting the public health option will fundamentally transform the mechanics of the Constitution and the basic relationship between government and citizenry. Make no mistake; the implementation of a public health insurance option will place us on a very dangerous road indeed. FINANCIAL ASSISTANCE TO PAY FOR HEALTHCARE. The concept here is that the government would provide subsidies to certain Americans who it believes should be assisted in paying for their health insurance. Biden Favors. The Biden plan would cap payments on healthcare insurance to 8.5% of one's income. It does not explain how such a cap will work. It also will increase tax credits for healthcare insurance and use gold healthcare insurance rates as the standards from which those tax credits will be calculated rather than the presently employed silver plan. Trump Opposes. These selective credits demonstrate undue interference of government on the market and would work as an extension of the disastrous Obamacare plan. The President would much rather do away with Obamacare and pursue healthcare delivery optimization in a totally different, market-based direction. Gonzalez The centerpiece of the Gonzalez plan is a transition of healthcare funding to a health savings account (HSA) based system. As such, our tax incentivization structure ought to be redesigned to encourage the formation of robust HSA accounts by each American. Doing so will unleash free market forces into the healthcare industry and rid us of those artificially contrived contaminants that presently keep the market from achieving its most efficient steady state. A successful transition will mean greater autonomy in selecting one's care and in ridding the individual of the dependence on corporate behemoths or government constraints when seeking healthcare. Removing the middlemen from funding and contracting considerations will necessarily result in greater provider accountability to the patient and improved quality of care. MEDICAID. Medicaid is a federally and state funded, state-administered program designed to provide assistance to the poor and disabled. Biden Favors expansion of Medicaid coverage to include those who are 138% of the federal poverty level and below. Trump The Trump Administration opposes this initiative. Instead, the President's goal is to improve the economy, have more Americans become self-sufficient through great job opportunities, and thus have more Americans contract with private insurers, ridding them of their dependence on government. Gonzalez Like in President Trump's plan, the Gonzalez plan also opposes Medicaid expansion as being counterintuitive to the goal of optimizing patient autonomy. Although I agree with the overall Trump plan of expanding America's economic standing and thereby decrease unemployment, the goal should not be to have more Americans contract with insurance companies for their care. The goal should rather be to have Americans transition to the independence of an HSA-based system of healthcare funding. I also agree with President Trump's plan regarding the fundamental importance of a maintaining a safety net for those who are unable to fend for themselves. STOP SURPRISE MEDICAL BILLING. Surprise medical billing is a situation that occurs when a patient seeks care in a hospital and is surprised by a bill from a physician who does not participate in his or her healthcare plan but who provided medical services in the care of the patient. Examples would be an anesthesiologist or radiologist who does not accept the patient's insurance plan, but who got involved in the patient's care because of his duties to the hospital where the care took place. Although the situation is not uncommon, it usually concludes with a payment resolution between the physician and the patient. Persistent disagreements are rare. However, the offensiveness of the experience and its potentially deleterious impacts on the patient's wallet makes this a very popular issue for politicians. The solution is actually difficult to achieve because most patient advocacy groups and insurance companies desire that the government, whether state or federal, mandate a low fee schedule that would apply in these situations. The goal, particularly for the insurer, is that the government come in and negotiate a price that is favorable to it. As a consequence, the physician would be forced to accept poorer reimbursements than they would be willing to accept, thus further pressuring private practices out of existence and resulting in the government working as an agent for the insurance companies. Biden Favors eliminating surprise medical billing and is comfortable with price setting in order to achieve it. Trump Favors eliminating surprise medical billing apparently through the development of an arbitration requirement between the insurer and the physician. Gonzalez Recognizes that if the nation's healthcare system were centered on HSAs, surprise medical billing would be a thing of the past as would pre-existing conditions. These would be obsolete terms because everything would be negotiated by the patient. The only exception would be in cases of emergency care for those who do not also have a high deductible insurance plan, in which case, a forced arbitration process would be preferred. CONTROLLING DRUG PRICES Biden Biden favors a centralized control of drug prices including the enactment of mandated prices and price caps. Trump Trump favors a centralized control of prices including the enactment of mandated prices and price caps. He also favors granting the United States favored nation status so that Americans may benefit from the deep discounts being offered by drug manufacturers to certain foreign nations. President Trump has also give some indications that he wishes to stem the power of group purchasing organizations (GPOS), which after price controls seem to be the biggest inhibitors against smaller competitors participating in a robust market. Gonzalez The Gonzalez plan eliminates the need for price controls. Today, there are over 240 medications that are not available or experiencing shortages in the United States. Amazingly, elemental medications such a penicillin, epinephrine, lidocaine, and bicarbonate are often missing and unavailable to our hospitals and patients. Indeed, the most frequently affected medications are non-patented, intravenous cancer medications. As explained in The Case for Free Market Healthcare, the primary reason for these shortages are price controls. In a truly transparent free market, the price of medications will naturally fluctuate to its most streamlined state minus shortages and minus a manufacturing exodus. This situation will naturally take place when HSAs form the staple of our healthcare system. The Gonzalez plan also closes the loophole on GPOs. IN SUMMARY Healthcare is a highly complex and multi-faceted silo in our society. The outcome of this election will play a monumental role in determining which of the two directions, either a free market based system or a government controlled one, our country will pursue during the first half of this decade. The conditions above are just a few of the major factors where the two parties differ. I can expand on many others. If you're interested in other subtopics related to healthcare, or if you have any questions, ask me by emailing me at aragonpublishers@gmail.com. I will be happy to answer your concerns in a public forum through this website. Dr. Julio Gonzalez is an orthopaedic surgeon and lawyer living in Venice, Florida. He served in the Florida House of Representatives. He is the author of numerous books including The Federalist Pages, The Case for Free Market Healthcare, and Coronalessons. He is available for appearances and book signings, and can be reached through www.thefederalistpages.com.
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 THE REAL CAUSE OF THE UNITED STATES' HIGH COVID DEATH NUMBERS WILL SURPRISE YOU. by Julio Gonzalez, M.D., J.D. One of the many points of contention brought up during Tuesday's fiery presidential debate was the issue of the United States' high coronavirus case and death numbers. The allegation of America's high numbers relative to its population was espoused by former Vice President Biden when he lamented that the United States owned 20 percent of worldwide deaths while possessing only 4 percent of the world's population. Predictably, he then did his best to pin the responsibility for these stark statistics on President Trump. Indeed, as of this writing, the United States has approximately 21 percent of the world's coronavirus deaths and cases, but the reason for this is never reported by the press and has nothing to do with the President's conduct. In fact, the reason may surprise you. As part of my book Coronalessons, which Amazon did its best to ban and whose existence it is still trying to suppress, I assembled data regarding the number of per capita cases and deaths of COVID-19 throughout the world. My team performed univariate analyses comparing the effects of a country's per capita COVID-19 case and death rates with its national healthcare ranking, per capita GDP, physician density, population density, and life expectancy. We selected the countries with the one hundred highest per capita cases of COVID-19 as of May 2, 2020, according to Woldometer.com and employed the demographic data published by the World Bank in our analysis. The nation's healthcare ranking was obtained from the admittedly dated world rankings published by the United Nations in 2000, the last year it did so.  The results were startling. Surprisingly, as the number of physicians per capita improved, the number of cases and deaths from COVID-19 exponentially increased! Figure 1. Relatedly, the better the country's health care system, the worse it performed. And when we looked at the number of hospitals per capita, the greater the hospital density, the poorer the nation performed. In fact, the mildest correlation we found was a nation's per capita testing with the number of deaths and cases. These results were contrary to our preconceived expectations. But the findings were explainable. Amongst the strongest correlations were those between a country's life expectancy and its per capita cases and deaths. Figure 2. This correlation was completely  expected based the virus's heightened threat to the elderly. What's more, for a nation to amass a greater life expectancy and thus a higher elderly population, it requires a robust healthcare system with lots of doctors and a myriad of hospital beds. And what's required to amass these? Wealth. Indeed, there was a direct, linear relationship between a nation's per capita GDP and its per capita cases (Figure 3) and an exponential relationship to per capita deaths. Figure 4 In short, the richer the nation, the more likely its citizens were to contract the disease and to die from it. But still the question remains, how is it that the higher number of per capita cases could be explained by a nation's per capita GDP? Here again, then answer is simple. Travel!  COVID-19 is spread purely through the intermingling of contaminated people with others who would otherwise not have come across the virus. It is to the richer nations that people travel, either due to business or pleasure, particularly early in the pandemic before anyone could do anything about it and before many even knew they were infected. With these factors in mind, one can almost predict the global course of COVID-19. As we know, the pandemic began in Wuhan, China. From there, the principal locations of its initial spread were to Italy and Iran through contacts related to the Belt and Road Initiative into which each country had entered with China. Recall  that even after China knew of the virus's propensity for inter-human transmission it did nothing to stop international travel from within its country. True to our predictions, the spread from Iran, a relatively poor and isolated country, did not blossom, but for Italy, the experience was entirely different. In Italy, the government tried, unsuccessfully, to contain the spread in the northern third of the country where the virus had entered via Chinese interaction, but the virus quickly spread south as Italians easily moved throughout the peninsula. In the meantime, a colossal soccer match in the northern Italian city of Atalanta allowed for the intermingling of Italians and Spaniards where the virus spread next. Shortly thereafter, in Madrid, the international women's march allowed for further spread to take place. A related dynamic began occurring in Europe that was also predicted from our correlations: the deaths of massive numbers of elderly patients. In Italy, the dynamics revolved around the sharing of living quarters between the younger generations and the older ones. In Spain, like in France and England, the decimations largely took place in nursing homes.
Additionally, throughout this time, travel was robustly taking place between China, Europe, and the United States. Like a hidden landmine ready to go off, the virus took hold in our population before we even knew it. Ours is the richest country in the world, and perhaps the most heavily visited. It was, predictably, the ultimate destination for SARS-COV-2, and without any means of detecting it, there was nothing the President or any other authority could have done to prevent it. Needless to say, shutting down travel from China on January 31 was logical and helpful, but in the end it was insufficient to keep the virus from reaching our shores, and our nation's epidemiology behaved exactly as our model would have predicted. Before closing, one other point is in order. If Biden is going to spuriously accuse the President of doing a poor job merely based on the United States' relative contribution to the global prevalence and death rates of the virus, he should even more zealously criticize New York, which is singlehandedly responsible for 15% of the nation's COVID-19 deaths. Governor Andrew Cuomo recklessly ignored the already established pattern of nursing home vulnerabilities by irresponsibly and selfishly insisting that hospitalized elderly patients be transferred there. Under his watch and because of his actions, New York's nursing homes became a cesspool of death and infection when many of the fatalities could have been prevented. So what's the real cause of the SARS-CoV-2's attack on the United States following China's disregard for the wellbeing of its neighbors? The answer is the world's attraction to the United States because of its wealth coupled with the relative advanced age of its population due to its superior healthcare. But neither the mainstream press nor Mr. Biden will ever admit to this because it would decimate their false claims against President Trump. And thus the true cause of our plight with this pandemic remains hidden from the public. For more findings on the COVID-19 pandemic that are not reported by the press, such as information on hydroxychloroquine, the timeline of the pandemic, China's and the WHO's roles in propagating the disease, and the disruption of constitutional constraint by certain governors, please go to our store and get your copy of Coronalessons. Dr. Julio Gonzalez is an orthopaedic surgeon and lawyer living in Venice, Florida. He served in the Florida House of Representatives. He is the author of numerous books including The Federalist Pages, The Case for Free Market Healthcare, and Coronalessons. He is available for appearances and book signings, and can be reached through www.thefederalistpages.com.  HOW I WOULD TREAT THE PRESIDENT OF THE UNITED STATES.
by Julio Gonzalez, M.D., J.D. By now, most of us have learned that President Donald J. Trump has tested positive for COVID-19. As was the case with the illness affecting Prime Minister Boris Johnson, a condition affecting the health of a world leader carries with it major ramifications to practically every aspect of life. As such, preserving the health and wellbeing of such a leader, irrespective of any campaign challenges, is of paramount importance. So the question now becomes, what's the best way to treat the President of the United States when he is suffering from COVID-19? The most important initial step is not to panic. Remember, the death rate associated with this illness is about 0.65 percent; that is, less than one in one hundred patients afflicted with this condition actually succumbs to its effects. Yes, the death rate is higher amongst elderly patients who contract the disease, and the President is 74 years old, but the President is a robust, highly active, and exceedingly strong individual. Physiologically, he is much younger than his chronological age would imply. Next, of course, I would examine the patient to ascertain the full extent of the virus's effects on his physiology at this time. Forget about telemedicine. There is no substitute for a careful and meticulous physical examination when planning out a patient's care. And yes, I would don full protective gear in so doing. Having established the President's state of health, what's next? First, it is imperative that the President be well hydrated, appropriately nutritioned, and rested. Next, if there are any organ systems that are affected, they need to be supported. For example, if he is suffering from nausea or vomiting, he would be placed on clear liquids or hydrated with intravenous fluids. If he has respiratory issues, then perhaps medications such as bronchodilators and antihistamines may be in order. If he is having a fever, then an antipyretic such as acetaminophen may be in order. And now to the controversial interventions. Yes, SARS-CoV-2 has been with us for nearly a year at this point, but we still do not have consensus on the best treatments for this condition. Although medications such as remdesevir, hydroxychloroquine, and azithromycin are supported to varying degrees in the literature, there is no consensus on how they are best deployed and under what circumstances. One thing is clear: thus far, there is no cure for COVID-19 other than the body's ability to eradicate the submicroscopic invader. So, with the available literature, and my personal experience with patients afflicted with this condition, here is what I would do. First, I would place the President on 200 milligrams of hydroxychloroquine daily, with a loading dose of 400 milligrams. I would continue the regimen for at least two weeks. Additionally, I would start the President on 500 milligrams of azithromycin daily for about ten days. I would also start the President on zinc and vitamin D, as it appears that deficiencies of these substances make a patient more vulnerable to the disease. I would then monitor carefully. If the President develops more severe respiratory symptoms, then a glucocorticoid such as dexamethasone may be indicated in order to prevent the cytokine storm. Remdesevir is a valuable weapon in the event the President's course should worsen, and of course, I would offer similar treatments for the First Lady and Hope Hicks, the President's Senior Counselor. Additionally, in an effort to protect those around him, I would isolate the President. Finally, I would pray for the President's recovery, as I would for the First Lady, Ms. Hicks, and all those afflicted with this potentially devastating disease. Most importantly, I would pray for this nation and for goodness, love, and light to overwhelm the evil, hatred, and darkness that is afflicting us. Of course, this latter intervention is one in which we can all fervently engage. Dr. Julio Gonzalez is an orthopaedic surgeon and lawyer living in Venice, Florida. He served in the Florida House of Representatives. He is the author of numerous books including The Federalist Pages, The Case for Free Market Healthcare, and Coronalessons. He is available for appearances and book signings, and can be reached through www.thefederalistpages.com. |
AuthorDr. Julio Gonzalez is an orthopedic surgeon living in Florida. He is a lawyer, author, and former member of the Florida House of Representatives. He is available for speaking engagements at thefederalistpages@gmail.com ArchivesCategories |
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