Tuesday, March 7, 2017

The "replace" plan is out this morning.

It's ONLY 120 pages, which makes it possible to read, unlike the thousand pages of Obamacare.  I haven't read it myself, so what I am writing here I get off the TV.  The bill keeps the ban on preexisting conditions, and kids up to 26 years old can stay on there parents insurance. 
  It offers "Tax Credits", presumably for buying insurance, possibly for paying medical bills.  If I remember my IRS form 1040, tax credits are better than deductions.  A deduction reduces your taxable income (adjusted gross income) whereas a credit reduces your tax.  For example, a $100 deduction reduces your tax bill by your tax rate times the deduction, usually amounting to $20-$30.  A $100 credit reduces your tax bill by $100.  This is a good idea.  It levels the playing field between most of us, who get our health insurance tax free thru our employers, and the self employed who get no kind of tax break at all. 
   On the other hand, half the population of the country is so low on the economic ladder that they owe no income tax at all.  Tax credits don't do you any good if you don't owe any income tax.  
   The plan fails to allow sale of health insurance across state lines, a measure that would increase competition
 and lower costs.  Everybody except the insurance companies is in favor of interstate sale.  Failing to put it in is a squishy soft cave in to the insurance companies.   Insurance companies don't vote, nobody likes them much, but they have a lot of money to buy Congressmen with.  Looks like they bought themselves a lot of Congressmen on this one.  Congressmen go for cheap this year.
   The bill also fails to require Medicare and Medicaid to bargain with big pharma over drug prices.  Again everybody (even insurance companies)  thinks this is a good idea.  Nobody likes big pharma much and they don't have the vote.  But big pharma  does have money, same general amount as the insurance companies, and they have bought themselves plenty of low priced Congressmen. 
  The bill fails to do anything to reduce the cost of health care, like clamping down on malpractice suits (lawyers like malpractice and nearly all Congressmen are lawyers). It doesn't allow duty free import of drugs from any reasonable first world country, which would do a lot to lower drug prices.  It doesn't rein in the ever growing FDA requirements for more and more testing of new drugs.  It does nothing to rein in the outrageous marketing expenditures by big pharma. 

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