EDITORIAL: Wednesday Trumpcare will afflict the afflicted, comfort the comfortable

May 10--Trumpcare would only afflict the afflicted and comfort the comfortable.

It would be great for the wealthy and the healthy -- and anything but for the sick, the old and the poor.

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And Trumpcare would work best for those who won't need it. It would be the equivalent of giving a no-interest auto loan to a millionaire who already has three Maseratis parked in a climate-controlled garage.

Many health industry analysts have described Trumpcare this way:

It's no better than Obamacare.

It's just bad in a different way.

And they're right.

The American Health Care Act slashes taxes for the wealthy, raises premiums for the elderly and provides incentives for insurers to bump the sick into unaffordable high-risk pools.

Older people with lower incomes buying their own insurance would be hit hard by the bill, said a Kaiser Family Foundation spokesman in The Wall Street Journal.

Ten leading patient groups have criticized the plan, such as the American Cancer Society Action Network, reported the Hill news service.

Jacksonville physician and financial analyst Carolyn McClanahan recently put it well in her Forbes magazine blog:

"It isn't Obamacare people hate," McClanahan wrote, "it is the complexity and the outrageous cost of the health care system. The American Health Care Act will address neither of these issues and most likely will make matters worse."

As this page has been stating since Obamacare was first proposed, cost must be addressed -- or no health care system will succeed.

And any bill that affects one-sixth of the economy needs bipartisan buy-in.

The Republican alternative to Obamacare fails on both counts as well.

McClanahan makes these suggestions:

--Fix the fee-for-service system, which provides incentives for costly and ineffective procedures.

--Simplify the crazy billing system, which frustrates doctors and patients alike.

--Get rid of the health care bureaucracy, which treats patients like numbers.

--Provide more price competition for pharmaceuticals, which are so much cheaper in other developed nations.

--Drastically reduce the use of emergency rooms for care that is not an emergency.

McClanahan suggested moving all the money being spent on Medicaid to federal health care clinics. This would provide incentives for primary care.

The American Health Care Act does not fulfill President Donald Trump's campaign promise, which looks just as empty as Obama's.

Now the Senate goes to work.

The Senate should study the proposal from Sen. Susan Collins, R-Maine, and Sen. Bill Cassidy, R-La., a physician. It would basically use a states rights model.

Liberal states that like the Obamacare model could keep it. And more conservative states would be given options that fit their culture.

Unfortunately, the 13 members of the Senate working group announced by Senate Majority Leader Mitch McConnell do not include either Collins or Cassidy.

Nor is there a Democrat or a woman in the group. That's not a good way to build broad, bipartisan support.

EAT CAKE AND KEEP IT

The typical voter wants goodies without having to pay for them.

And in answer to pollsters, Americans don't want the individual mandate. But they do want affordable insurance.

But insurance will never work if people are signing up when they're sick and then leave when they're healthy.

Consumers either need a carrot (incentives) to sign up or a stick (the mandate) to get healthy people into the insurance pool.

We tend to favor incentives. But we sure don't see much in the Republican plan that helps.

As a Harris poll noted, "People can be rather generous when they believe somebody else is paying the bill."

So 81 percent support requiring insurers to cover people with pre-existing conditions, 66 percent support subsidies for low-income people, 54 percent favor expanding Medicaid and 58 percent support repealing the mandate.

As Trump said during a town hall event: "Now, the new plan is good. It's going to be inexpensive."

Sorry, but that's not true of the House bill. It needs major repairs in the Senate.

THE FLORIDA ISSUE

One way to lower the cost of health care is to keep people out of emergency rooms with better primary care.

The federal government has been compensating Florida hospitals for treating many poor people in emergency rooms. It's not a cost-effective system.

Public hospitals like UF Health Jacksonville rely on this federal funding, which was placed in jeopardy under the Obama expansion.

Under Obamacare, it was presumed that expanding Medicaid would remove more nonpaying customers from hospitals, thus lessening the need for federal subsidies.

But when Florida and 18 other states refused to expand Medicaid, that meant the federal subsidies still were needed.

Now the federal government has tentatively agreed to continue payments to the low-income pool, which is fine in the short term but leaves an expensive system in place for the long term.

So Florida officials, rather than expanding primary care through Medicaid, are endorsing this flawed system.

It's costly and ineffective

PRE-EXISTING CONDITIONS

One key to health insurance is finding affordable policies for people with pre-existing conditions.

The Republican answer is to put these people in high-risk pools. But to make them affordable, they have to be subsidized.

Many previous high-risk pools didn't work because they had high premiums, long waiting lists and poor coverage.

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