TRUMP HEALTHCARE V. BIDEN HEALTHCARE. WHICH IS BETTER AND WHY?

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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