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HEALTH CARE


  1. Introduction

  2. The First School of Thought

  3. The Second School of Thought

  4. H.R. 3590 Patient Protection and Affordable Care Act (PPACA)

  5. Summary of the Patient Protection and Affordable Care Act (PPACA)

  6. Criticisms against the Patient Protection and Affordable Care Act (PPACA)

  7. Candidates' Position



I. Introduction

Health care is one of the most ideologically divisive issues in the country, with wide ranging implications affecting not only the health care industry (providers, employees, beneficiary industries) itself, but the average Americans in general, as well as the government (both at local and federal level), along with the national economy, owing to its sheer size.

This very complex subject unfortunately has been reduced to two chief fundamentals, namely, the mechanics of cost and the scope of coverage.

There are two major schools of thoughts dominating the mainstream thought process when it comes to the American health care system.

II. The First School of Thought

The first school of thought (primarily in the conservative sphere) believes that the federal government's involvement in health care should be similar to every other sector of the economy - minimal. The healthcare industry should be left to its own devices, and allowed to achieve a point of maximum efficiency through a system of trial and error based on our own unique blend of free market economics- the very same organic process that successfully propelled the American economy to become the largest in the world. The health care industry must learn to navigate itself through the vicissitudes of the open market, without the comfort of a federal safety net blunting its competitiveness and natural ability to evolve. Case to the point: this process of trial and error has already exposed the impracticability and harmful effects of a federal or state mandate on health care economics, which almost always result in insurance firms building additional cost into their premiums.

III. The Second School of Thought

The second school of thought (primarily within the liberal sphere), on the other hand, believe that health care is not a business. It is the fundamental right of every member of our society to have access to health care. By subjectively abdicating the responsibility of managing the national health care, and handing the task to the fragmented, uncoordinated and capitalistic private enterprises, we are risking the health and well-being of millions of Americans. Private firms, by its very nature, are chiefly answerable to their shareholders, and thus, will attempt to minimize its business risks and increase its return of investments by excluding the weakest and least commercially viable members of the society from health care coverage. The aged, the poor, the chronically ill and the high risk demographics will inevitably be left in the sideline as insurance companies and private healthcare providers pursue their overarching strategic goals. Furthermore, the United States is one of the last remaining developed country that has yet to implement a universal healthcare system. This is despite the fact that the United States spends more on health care per capita ($8,937) than any other developed countries. 29 of the top 31 developed countries in the world has a universal health care system (twelve single payer, nine two tier, and eight insurance mandate).

IV. H.R. 3590 Patient Protection And Affordable Care Act (PPACA)

The exponentially accelerating cost of health care has been a major source of concern for successive American administrations since the Nixon presidency.

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In fact, there have been numerous health care proposals flying around the Capitol over the last four decades; nonetheless, there have been only incremental reforms and tweaks enacted thus far.

However, on March 23, 2010, President Barack Obama's controversial H.R. 3590 Patient Protection and Affordable Care Act (Full Text), referred to by many as Obamacare, was signed into law. It is the most transformative piece of legislation passed by Congress since the enactment of the Medicare Legislation of 1965.

V. Summary of the Patient Protection and Affordable Care Act (PPACA)
  1. Mandate for businesses (exception applies) and individuals to have an approved level of health insurance, enforceable by penalties

  2. A federal subsidy program to pay, either in part or full, the health insurance of 34 million uninsured American to comply with item 1.

  3. Prohibition for insurance providers to deny coverage based on preexisting conditions, a move which is expected to extend coverage to an additional 20% to 66% of the U.S. adult population, approximately 36 to 122 million Americans (Source: Government Accountability Office, Estimates of Individuals with Pre-Existing Conditions Range from 36 Million to 122 Million, March 27, 2012)

  4. A range of regulatory changes related to the Patient Centered Outcomes Research Institute (PCORI) and the Independent Payment Advisory Board (IPAB), including discounts on physicians reimbursement claims

  5. Health insurance exchanges

  6. Expanded access to Medicaid

  7. Staggered rollout beginning from June 12, 2010, to 2018



VI. Criticisms against the Patient Protection and Affordable Care Act (PPACA)
  1. The creation of mandates for businesses and individuals, as well as the introduction of a range of new regulations, expands the federal government's role in health care into unhealthy levels and encroaches on the personal liberty of individuals

  2. The creation of a federalized subsidy system, through a mixture of health insurance exchanges and Medicaid expansion to enable uninsured Americans to comply with the federal health mandate

  3. Penalizing healthier and younger insurance policy holders with higher premiums to subsidize uninsured Americans

  4. No real efforts to tackle the spiraling cost of health care

  5. Questionable figures used to calculate the PPACA's actual cost, with some claiming that it will actually increase health care costs by a significant margin

  6. The coverage is not universal, and as many as 20 million Americans are expected to remain uninsured upon the plan's full enactment



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2012 Libertarian Presidential Nominee
Former Governor of New Mexico

Gary Johnson

Presidential Candidate Gary Johnson

Johnson Position on Health Care

Gov. Johnson believes that a bloated legislative and regulatory environment is depriving our healthcare system of the ‘competition factor’, leading to inefficient government-sanctioned monopolies.

He considers President Obama’s Patient Protection and Affordable Care Act of 2010 as unconstitutional and intends to repeal it, along with former president George W. Bush’s Medicare prescription program.

A Johnson presidency would see an immediate 43% cut on federal Medicare and Medicaid funding, with the remaining amount redirected wholly to the states, no strings attached.

Johnson believes health care should be left to the states, and allowed to grow in a free market environment.


"I’m promising to submit a balanced budget to Congress in the year 2013 that will detail a 43% reduction in Medicaid and Medicare. Before anybody falls of their chair, with regard to a 43% reduction in either of those categories, it’s important to point out that if we don’t balance the federal budget, we’re gonna find ourselves without any health care at all.

So as Governor of New Mexico, I oversaw the reform of Medicaid in New Mexico. Health care to the poor - changed it from a fee for services model to a managed care model, set up better health care network, saves hundreds of millions of dollars.

I believe that at the time, if the federal government would, were to have block granted the state of New Mexico 43% less money, done away with all the strings and mandates, that I could’ve effectively overseen the delivery of health care to the poor in New Mexico. I think the same model applies to Medicare. Fifty laboratories of innovation and best practice. The federal government has to give it up to the states."


Apr 28, 2012: Johnson speaking at the Fort Worth Libertarian Party of Texas Presidential Debate




"You got to start out by talking about Medicare and Medicaid. I'll just throw out some suggestions here. There are other, but let me just throw the fact that the federal government could cut Medicaid and Medicare by 43 percent…

… They could block grant the states. I'm going to say this throughout my campaign, 50 laboratories of innovation, the notion of best practices. Give it to the states to deliver health care to the poor and those over 65 and do away with the strings. Do away with that regulations - Let states handle it. There would be best practices emerge. Other states would emulate the best practices. They'd be failure. States would avoid the failure.

In New Mexico, Medicaid, now it came with all the strings attached. It came with all the regulation attached. It came with a mandate that here are the services that you had to deliver, but Medicaid in the State of Mexico, I shifted that from a fee for service model to a managed care model and saved 25 percent. If I were to have been given Medicare, I could have done the same thing with Medicare and saved 25 percent. By the way, I used 25 percent. I could have saved more money. I still could have delivered health care to those truly in need by cutting it 43 percent, I could have done that. But I was governor of the state. I had a legislature that was 2/3 Democrat and, you know, I wasn't the benevolent dictator."


May 27, 2011: Johnson on Hannity' Primary




Johnson: Specifically, and this is waving the magic wand, because I recognize that there are three branches of government, I would have the federal government cut Medicare and Medicaid by 43 percent and block grant the programs [to the states] with no strings. Instead of giving the states one dollar—and it’s not really giving because there are strings attached—the federal government needs to give the states 57 cents, take away the strings and give the states carte blanche for how to give health care to the poor. I reformed Medicaid as governor of New Mexico and, in that context, even with strings attached, I believe I could have delivered health care to the poor. I believe I could have done the same thing with Medicare…

Holleran: Will you issue an executive order to repeal Obamacare as unconstitutional?

Johnson: Yes, if it’s possible. I would do the same for [President Bush’s Medicare] prescription [drug subsidies]. Two parties can take responsibility for where we’re at right now.


Aug 21, 2011: Interview with Gary Johnson, scottholleran.com


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