The Healthcare Election

by Gerard J. Gianoli, M.D.

With news of more exchanges closing, fewer healthy enrollees signing up, insurance companies pulling out, and health insurance premiums set to spike, this October we will see a tighter turn in the death spiral of ObamaCare. There is no doubt about the higher premiums and lack of choices in ObamaCare. What should be done in its aftermath is up for debate. This makes the November presidential election a significant turning point in our national healthcare conversation.

When it comes to American medicine, the choice for president is as stark as it ever has been: go further down the road to complete government and insurance company control over the “healthcare system,” much of which is devoted to financing and administration, or begin turning to a more patient-doctor directed, personalized, free-choice system. From my perspective as a physician (and as a patient), Donald Trump offers far more hope than what Hillary Clinton has already announced: repeal Obamacare vs. double down on this top-down, centrally controlled, anti-choice system.

A side-by-side comparison of the two candidates’ plans by the Kaiser Family Foundation shows basically this for Clinton and Trump, respectively:

  • More taxpayer subsidies, more mandated benefits, a “public option,” price ceilings on insurance premiums and out-of-pocket spending (Clinton) vs. more insurance options [across-state-line purchases would bypass costly state mandates]; tax deductibility for premiums, and expanded health savings accounts (Trump)
  • Spending $500 million to advertise subsidies and Medicaid and more federal funding to encourage Medicaid expansion (Clinton) vs. block granting Medicaid to states (Trump)
  • Allowing people age 55 to 64 to buy into Medicare [Ponzi schemes constantly need new “investors” to pay the early “investors”] and stop paying for services rendered but only for “value” (Clinton)
  • Limit out-of-pocket spending for covered prescription drugs (Clinton) vs. allowing more competition (Trump)
  • Fund Planned Parenthood and repeal the Hyde Amendment, which forbids taxpayer funding of abortions (Clinton) vs. defund Planned Parenthood and make the Hyde Amendment permanent

Some Republicans are concerned about Trump’s rehabilitated positions on some issues and say “we don’t know what he’ll do once in office.” Clinton, on the other hand, has been completely consistent in what she wants for healthcare, at least since she headed the Clinton Task Force on Health Care Reform in 1993.

This contest is not about likability. It’s about who will enact an agenda that will propel the U.S. towards a path of greater health, prosperity and safety—or the opposite. Regarding your medical care, this election boils down to a choice between more government intrusion or less; free-market medicine vs. government controlled markets; individual liberty vs. Washington, D.C. decision-making for your medical treatment; and patient privacy vs. government intrusion into every aspect of your life.

It is true that Trump at one time said that single payer medicine seemed to work in some places. But his views are changing. As a doctor, I would be concerned about a colleague who maintains the same views even as he matures and experiences practice with all of its lessons learned. The physician who fails to learn from new research, techniques, or personal growth is the one to be feared, not the one who alters recommendations or treatment plans after learning of better ideas and techniques.

The biggest objection by many of the establishment Republicans may be that Trump is simply an outsider who lacks government experience. The reticence to let someone who doesn’t like your rules into your clubhouse is understandable, but let’s remember: The Republican clubhouse has not been at 1600 Pennsylvania Avenue since January 2009. As to experience, where have our pedigreed elected officials brought us thus far? Terrorism at our doorstep, riots in the streets, almost $20 trillion in debt, 46 million on food stamps, and a healthcare system that is in a death spiral. It will be hard for Trump to do worse.

We need to remember what Ronald Reagan said: “Government is not the solution to our problem. Government is the problem.” This is so right when it comes to medical care. Virtually every intervention our government has employed with regard to medical care, starting in 1965, has made it more expensive, less efficient, and less private. It has interfered with quality and led to vast amounts of fraud, abuse, and waste.

With medical care, the question for the election boils down to this: the prospect of less government involvement in our care, or a guarantee of continued progress to a complete government takeover.

Gianoli_110Dr. Gerard J. Gianoli specializes in Neuro-otology and Skull Base Surgery.  He is in private practice at The Ear and Balance Institute, located in Covington, but is also a Clinical Associate Professor in the Departments of Otolaryngology and Pediatrics at Tulane University School of Medicine.  He pioneered treatments for Superior Semicircular Canal Dehiscence and other vestibular disorders.  His private practice has a worldwide reach, with patient referrals coming from all over the United States and from around the world.

Dr. Gianoli opted out of Medicare in 2001 and has had a 100% third-party-free practice since 2005.  He’s lectured and written extensively (as well as had numerous media interviews) on third party free medical practices and free market medicine.  His editorials have appeared in The Wall Street Journal, Forbes, Investor’s Business Daily, The Hill and other popular periodicals.

He has received numerous awards, including the American Academy of Otolaryngology’s Honor Award, and has been named in America’s Top Doctors and America’s Top Physicians every year since their inception in 2001 and 2003 respectively.  Dr. Gianoli practices all aspects of neuro-otology but has a special interest in vestibular (balance) disorders.  He has researched, lectured and published extensively on the topic of vestibular disorders.




The Healthcare Election — 2 Comments

  1. Gerry, this diatribe is an extraordinarily superficial and specious analysis which appears to be a whole-cloth transcription of Trumpian nonsense. Obamacare premiums are high because medical costs are high and because health care insurance companies are profit-making businesses which essentially operate on a cost-plus basis. Medical costs are higher in the US than in the rest of the world because doctors, pharmaceutical and medical supply companies, and hospitals operate as capitalist entities. That’s just how it is. All of the aforementioned have, to one extent or another, promoted themselves into elitist crypto-aristocracies.

    There’s nothing the matter with success. I am a capitalist. I’ve run my own business for 40 years. I am a success, and I do not criticize or undervalue success, achievement and self-sufficiency. But the declaration that Obamacare, rather than a preoccupation with inordinate economic success by the medical supply side, is the cause of high healthcare costs is insupportable. There cannot be a cheaper medical care system, including insurance, without reductions in the profit margins of the medical supply side.

    The assertion that interstate competition among healthcare insurance companies is some sort of panacea is simply false. See , as well as: “The pros and cons of selling health insurance across state lines – AEI | Politics and Public Opinion Blog » AEIdea.”

    Albert Einstein observed that politics is much harder than physics. Once again the gentleman hit the nail on the head. Relativity is easier than the control of medical costs in a political and economic system like ours. The over-simplified and Republicanized analysis you provide is just wrong.

  2. Steve, “greed” and “profit-making” didn’t start with Obamacare. They’ve been around for a long time. The difference is that ACA has worsened a situation that has been growing in medicine since 1965 – crony capitalism. The prices in any medical field where true free market competition really exists (e.g. cosmetic surgery, refractive eye surgery) have actually come down while quality has improved.

    The current death spiral in ACA is undeniable. The premiums keep going up because the only people signing up for the plans are those who need care and when they’ve received their care, they stop paying. Currently, “health insurance” is not really insurance, but payment plan for “get-as-much-as-I-can-care”.

    I did not claim that interstate commerce would be a panacea, but only point it out as a difference between the candidates. I personally think it would have a minimal effect. Insurance is not the way to control costs – due to our current situation, moral hazard has led to ever increasing costs. Insurance is a big reason for the escalation of prices – one only has to look at the cost of prescription meds, since the increase in insurance coverage, prices have skyrocketed.

    I’m sorry if you felt my editorial was “superficial and specious”, but there is only so much one can do in 800 words. Maybe we should discuss this in person some time.

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