Trump’s ideal healthcare model

Donald Trump campaigned on getting rid of Obama’s insurance healthcare model, and replacing it with a healthcare scheme that “everyone would love.”

An ideal healthcare model cannot be based on insurance. The problem with such a scheme is that there is no upper limit to the cost of an insurance based scheme. So, in the USA, healthcare is running at 17% of GDP.

The problem with an insurance-based healthcare scheme is that there is no direct connection between the cost of the service provided and the payment for the service. Insurance companies may try to limit their payments, but are clearly failing to do an adequate job.

Healthcare Funding

Healthcare funding is inherently difficult. Everyone wants the best healthcare that can be provided, but not everyone can pay the price. In fact, no country can actually pay for every healthcare need or demand of its people. A rational approach to rationing healthcare spending is required. This should target to meet, at least, fundable critical needs from a general pool.

Doctors are the key

There are many doctors who have entered the health profession primarily to serve the public, not to make $1 million dollars a year in fees.

Such doctors would be prepared to provide services to patients on a government-set fee for service. Those doctors who accept this arrangement would be legally blocked from charging their clients anything in addition to the government-set fee.

The fee should be set to provide a generous return to the doctor, taking into account a proper return for the years of study, expertise and work involved. Where there is a shortage of available GPs and specialists, an increased fee will be provided while this shortage exists.

A scheme like this would provide for a government funded fee for service for GPs and supported in-hospital medical procedures. Such a scheme is likely to be much cheaper to the US economy than the current insurance-based scheme.

This scheme could be funded by a fixed Federal levy on gross personal income and “net business turnover” (turnover less wages cost) in the USA. It should be set prudently at a high enough level to meet the cost. If this levy was reasonably set at less than 17% it would represent a net saving to the US economy. Based on this funding model, healthcare cost is likely to be less than 10% of personal income and net business turnover.

State-funded hospital care

State-funding of hospital functions on a fixed fee for service arrangement is a viable method that has been used elsewhere.

Non-profit hospitals could opt to be state-funded, and new state-owned hospitals could be commenced. Those hospitals that accepted this arrangement would be legally blocked from charging their clients anything in addition to the government-set fee for the nominated procedures.

This scheme should also be funded out of the Federal levy.

Medicaid Healthcare Funding

No further Medicaid funding would be required, and any other Federal subsidies for medical care would end.

Private Healthcare Insurance

For those who prefer to be privately insured, and to use current fee-for-service arrangements, this can be accommodated within this system.

In this case, the insurer would be required to make a claim for a percentage of the fixed fee (say 80%) from the Federal government, based on the same fee-for-service scheme, for supported services, used by doctors and hospitals .

Political Policies in Australia

Political Parties need coherent political policies. The recent elections in Australia, UK and USA prove that personalities do not matter as much as believable political policies.

Here are a range of policies that non-socialist Australian political parties could forward believably to the Australian electorate, and which would be appealing to a majority of voters.

Employment and Business:

  • Our primary goal is “a job for everyone who wants one.”
  • We consider that jobs are more important than “low prices for everything!”
  • To create jobs, the nation needs business investment.
  • Investment and profit from investments is a necessary part of a successful economy.
  • Improving the profitability of Australian businesses is a key goal of our party.
  • Improved profitability allows businesses to employ more people and to pay better wages
  • We believe improving profitability is more important than reducing business taxes.
  • To achieve these things, we will:
    • Encourage export activities where Australia has a relative comparative advantage, or where an Australian-driven innovation gives a particular business an advantage.
    • Fund the CSIRO to continue to do fundamental research that the organisation believes to be in Australia’s interests. The CSIRO will report annually to the Parliament on the previous year’s activities, demonstrating the relevance to Australia’s prosperity of the focus of their work.
    • Introduce a base-level 15% tariff on all inwards goods and services. We will also a support higher tariffs on goods and services where these are imported from countries which are judged by Australia to be unnecessarily allowing their own people’s wages to be set too low.
    • We will not require tariffs to be applied to high value equipment imports. Instead, we will support any local manufacturing of these via a subsidy.
  • We believe Australia should be active in reforming WTO rules, which are currently out of touch with the current economic environment. The WTO will not be permitted to frustrate our legitimate national ambitions.
  • The Productivity Commission will be required to assess the employment consequences of their recommendations, including assessing the real alternative employment prospects for displaced workers.

Monetary policy:

  • We believe that Australian businesses can have access to the necessary local financial resources to fund most of their own development, and should not be overly dependent on overseas cash flows into the nation. Therefore:
    • The Reserve Bank will be required to restrict the over-valuation of the Australia dollar, with appropriate interest rate policies, and by offsetting speculative currency flows into Australia.
    • The Foreign Investment Review Board will be required to assess and report on the non-financial benefits and costs of intending foreign purchases of existing very large Australian businesses and assets.

Budget repair:

  • We will establish a route towards a small “situation normal” budget surplus by 2021.
  • We will require new superannuation contributions to fully-fund individual pension needs, until the individual’s new superannuation money runs out.
  • Medical insurance will no longer be subsidised. Instead, all doctors will be encouraged to bulk-bill, including for hospital work. Medicare rebates will be lifted to provide a level of income for GP and specialists that is judged to be appropriate given the training, skill and risk involved in this work.
  • We will closely monitor and eliminate all attempts to use government funded programmes in a way that exploits too-easy government funding.
  • Tied grants to the States for state responsibilities will be eliminated.
  • Any significant new funding commitments will be met by increasing taxes, and will not proceed without appropriate funding (no more unfunded NDIS-type and Gonski-type commitments).

National Government

  • We support a federal model of government for Australia, with clearly defined responsibilities for the Federal and State arms of government.
  • We will work towards the goal of State Governments being self-funding.
  • We support fixed 3 years terms for the Federal Government, with the caveat that the Governor-General (G-G) be empowered to call an election where the G-G believes that it is in the nation’s interests. The G-G must formally advise the Parliament and the public of the substantive reason for calling an early election: it cannot include reference to advice from the Prime Minister, but must explain the substantive reasons for the G-G’s decision in relation to the nation’s interests.
  • We support the appointment of a Governor-General by a majority of the members of the House of Representatives. This will happen three months after returns are finalised for each general election, and otherwise only if the office is vacated by the G-G due to death, resignation, or a Full High Court determination of incapacity.

Industrial relations:

  • We will work towards establishing and maintaining fair working conditions for both employees and employers.
  • We will support workers’ wages with policies that encourage private sector employment at fair wages.
  • The Fair-work Commission will set the minimum wages for each work category, replacing union-based awards.
  • The Fair-work Commission will be required to set penalty rates for weekend work and overtime to reflect community standards and to ensure that small businesses are not disadvantaged in comparison with large businesses.
  • Unions that seek to intimidate workers or businesses will be closed and funds confiscated. Such confiscated monies to be returned to members on the basis of member contributions over the previous 5 years. Any funds deemed to be illegally obtained by the union will be retained by the relevant government body and used for general expenditure purposes.

Agriculture:

  • We support a strong agricultural sector, both for export and local consumption.
  • We believe that, wherever possible, each nation should aim to be self-sufficient in agricultural staples. Therefore:
    • We see a role for large-scale agriculture in being a swing producer in the world market for grains and similar staples. We support on-farm storage of grains and we are willing to provide financial support for farmers carrying large stocks of these goods from season to season.
    • We support modest Australian tariffs for high-labour-cost products, such as citrus fruits and market gardens.
  • We support the export trade in livestock, as well as developing more regional abattoirs.

Resources

  • We support a strong state-based resources sector.
  • We confirm that states should charge royalties as they see fit.
  • We will not support any “Super Tax on Ordinary Profits,” charged at a federal level, irrespective of its configuration.

Superannuation

  • We will ensure that, in future, the Superannuation Guarantee Levy actually does its work of reducing the reliance of ordinary workers on a government-funded pension.
  • Existing Superannuation funds that are not set aside for a pension replacement income stream will be taxed at a reduced rate, but will no longer be tax free.
  • We support allowing access to accrued Superannuation money to fund the purchase of a first home. (A home is both a lifestyle asset, and an asset that is useful in retirement: it is a good use of Superannuation money.)
  • We are pledged to review the Superannuation Guarantee Levy over time with a view to reducing it, or giving employees earlier access to their own money by other means.
  • Australian governments to provide public-servant-run superannuation funds, each with a different profile, including an investment focus on Australian infrastructure and companies. Low fees will be a feature of all these funds.

Commonwealth-state relations:

  • States will be treated as adults, responsible to their own voters for how they spend their money, whether raised independently or from the GST.
  • GST will be spread per state on per-capita basis, but with a re-instated federally-funded Grants Commission (with a fixed annual budget).
  • We will establish clear definitions of federal/state responsibilities for funding and service provision, so that Federal / state duplications can be removed completely.

Indigenous Affairs:

  • We support the idea of innovative self-funding and self-governing indigenous communities.
  • We believe that all remote indigenous communities should be encouraged to provide most of their own services for themselves.
  • Therefore:
    • Where there is a clearly expressed desire for this to happen, we support indigenous communities being able to elect their own representive councils.
    • Such indigenous councils to raise their own rates, and to spend the money in ways that benefit their own communities.
    • As a starting incentive, federal government subsidies to be provided to such councils on a $1 for each $1 raised, with a plan to progressively reduce this assistance over a number of years.
    • Indigenous communities to be encouraged to have their own indigenous plumbers, carpenters and other relevant trades, living in their own communities.
  • As far as is possible, all services to indigenous communities to be provided locally, even where this is perceived not to be the cheapest way of providing these services. Federal funding will only be used locally and only used to pay wages to members of that indigenous community at the current Fair Work wage rates for work certified to be completed.
  • We will support moves towards state-based negotiations for a treaty with the descendants of First Australians. We will not support a federal treaty. We believe that a treaty is a regional issue, affecting every “mob” differently.
  • We will not support a change to the Australian Constitution to recognise the descendants of First Australians, unless there is a clear indication that an overwhelming majority of these descendants want this to happen.

Climate change:

  • We will target for a cap of 2.5 tonnes CO2 emissions per person per year by 2040 (current emissions are 15 tonnes per person).
  • We will argue in international forums for a target maximum CO2 level of 450 ppm (currently CO2 level is around 405 ppm, and growing by 2 ppm per year).
  • Preference and funding will be given to measures that will physically reduce emissions, rather than concentrating on failed economic schemes designed to achieved that effect.
  • Initially, stability will be returned to the Australian electricity market by mandating that no RET subsidy will be paid for electricity generated when it is not required. The RET targets will be adjusted accordingly. Furthermore, the current RET scheme will be capped at the legislated levels (adjusted as above), and not changed, up or down.
  • Renewables, beyond current RET scheme provisions, will be required to stand on their own, and not receive further subsidies.
  • We do not expect that this will cause any difficulties in achieving the above ambitious CO2 reduction target.

Education:

  • We support basic education standards being set federally, but states and schools being able to set curriculum within those standards.
  • We support state management of state-government schools. We propose federal oversight of non-government schools.
  • We will support 80% of all school funding being federally provided, based on Gonski 2.0 funding calculations.
  • We believe that education should be linked to students’ abilities and aspirations; not every student wants to go to university, but the vast majority of students want education to lead to meaningful employment.
  • We will enforce strict rules on HELP-funded technical education providers to ensure that they provide value for money.
  • We will work to provide an environment where state-based TAFE colleges can thrive.

Hospitals:

  • We propose federal funding of doctors’ fees in hospitals based on a fixed payment per procedure.
  • We propose that the states continue to fund all other costs in state hospitals.
  • We support state management of state government hospitals and propose federal oversight of non-government hospitals.

NDIS:

  • Operation of NDIS scheme will be closely examined and fine-tuned in order to keep funding and expenditure within community expectations, while taking into account community willingness to contribute to its funding.

Immigration:

  • An active immigration program will be supported, with a mix of humanitarian immigration and business-driven immigration.
  • In humanitarian immigration, preference will be given to those who are at high risk of systemic persecution and those who have a very good prospect of integration into Australian society.

Social policies:

  • We support same-sex relationship legislation and oppose same-sex marriage legislation.
  • We will support a public education campaign dealing with the facts of the health consequences of anal sex.

Environment:

  • We will protect the environment in accordance with the best science and in line with community expectations.
  • We will examine whether increased water storage facilities can be built economically and sustainably.
  • We will work towards the reduction of the usage of plastic bags and packaging.

ABC and SBS:

  • ABC and SBS will be required to demonstrate that they are meeting community expectations across all communities.
  • Funding of these organisations will be reduced if they cannot demonstrate this to Parliament’s satisfaction.
  • There will no further funding of SBS’ Viceland service.