Thank you, thank you, Dr. DiSalvo and to this great university. This is my third or fourth visit. The primary season is young, I’ll be back I'm sure. This is kind of the host to all things presidential and it is a joy to be with you all.
I am here to talk about something that is really important. How do we turn what we have into a 21st Century healthcare system? Not, not just insurance but the system altogether. How can we envision what a healthcare system could look like in 2025 rather than protect the version of 1975 which in effect is what we have now? America really if you think about it is a place of discovery and innovation and if we fix a few big things we can transform ourselves because we’re the most dynamic country in the world, not just healthcare but across the spectrum of policy to make lives better for ourselves and our children and our grandchildren. This is gonna require a new approach on how we allow people to stay healthy, how we reward that, treat illness, and support life-saving medical discoveries and care.
In fact, let me just give you a couple of anecdotes that I think will validate this in my own personal life. Next week or week after next on the 20th anniversary of an event my wife, Columba, and I have been involved in to raise money for cystic fibrosis. We’ve been doing it 20 years and when we began this people would say I can remember that children were dying before they became adults with this disease and people would say well, if we keep working hard eventually we’ll find a cure. Well, in fact today if you’re born with cystic fibrosis there are medicines that have been discovered in the last three or four years and more on the way that ultimately will allow someone with cystic fibrosis to live as long as everybody else. Our grandchildren being born today if we get this right will live way beyond 100 years. It creates huge challenges, but it’s also an opportunity for us to transform our society in a way that will allow more and more people to live lives of purpose and meaning.
But here’s the problem. The one thing I know is this, we can’t stick with the status quo. We can’t leave this up to the lobbyists and to the politicians in Washington, D.C. because the system we have today, Obamacare in its most current form was written by the special interests for the special interests. Let’s look at what had been promised and what we got instead. President Obama promised healthcare insurance premiums that they would fall by $2,500 per family. Now it’s estimated by the President’s own team that they’ll increase by $2,900 over the next 10 years. Right here in New Hampshire based on the rate filings that have taken place next year’s premiums are expected to increase anywhere from 20 to 50 percent. President Obama promised universal coverage. Based on government predictions, projections even after spending $1.7 trillion over 10 years they’ll still be 27 million Americans without health insurance during this 10 year period.
More than half of those getting insurance so far are enrolled in Medicaid, but it turns out that being on Medicaid isn’t necessarily a better deal than being uninsured. For those policy wonks in the crowd you may want to check the Oregon study that, that analyzed like-kind patients, like-kind people that had insurance and those that were receiving Medicaid. And what they found was the people that didn’t have insurance actually got better quality care. The notion that somehow access to insurance yields better results may not be the case if you look at the poor quality of Medicaid that is tied down by massive amounts of regulation and rules imposed by Washington, D.C.
The Obamacare website one of the classic disasters in modern government history was has now been overhauled at a cost of hundreds of millions of dollars. Two-thirds of the people who got an Obamacare subsidy found out later that they, they owed an average of $730 to the IRS. People who signed up for an Obamacare plan are finding that a third of the doctors and hospitals aren’t in their networks. The number of people dropping out of the plan according to the New York Times story that I read yesterday is growing as people realize that this is not full coverage, that they have to pay out of pocket costs and it’s better to pay the fine. You couldn’t escape the impact of this terrible law even if you were not in the exchanges or on Medicaid because the mandates and additional coverage requirements also are creating impositions for private companies. And all of this is being done with the largest tax increase in modern history on the backs of businesses and savers and American workers.
He imposed these rules that encouraged companies to cut hours for workers because markets work this way. The minute you create some kind of rule or imposition people adjust and the net effect is that millions of, of man hours and woman hours are gone because people are working part-time when they want to work full-time. In fact, people are losing their insurance when they had it before. It’s quite a legacy if you think about it, and when you consider the wreckage it makes you wonder who could any, how could anybody support this now? Well, Hillary Clinton supports it and so does Bernie Sanders and other Democrats, and the debate tonight in Las Vegas will probably prove that they will be strongly supportive of this top down drive, highly bureaucratic insurance plan that is stifling our ability to rise up. Because for the Democrats this is what they want. This is how they roll. This is what they like. They like the power of deciding these things from up above. This is, this is their essence. And I believe the top down drive approach is not the one for our country.
Whether it’s energy policy, healthcare policy, environmental policy, across the board we’re a bottom up nation. We’re a nation that does things much better when we empower people to make decisions for themselves rather than get in line and be told what to do. That’s what Obamacare is and there’s no way to fix it to be honest with you. You can’t fix something that is was a failure from the start. We have to start over. And when I become President I will work immediately to repeal and replace Obamacare with a system that looks more like the successful enterprises and successful systems of our great country.
Let me tell you how I’ll get it done. I will focus on what healthcare should look like, as I said. We need, we need a healthcare system for 2025 not 20, 1975. I believe we need to recognize the positive change and disruption all around us should be our friend not our adversary and especially true in healthcare. And we should liberate our system to allow for much more innovation to take place. Think about it. We have smart phones that can video chat with our doctors and caregivers, we have genomic medicine that personalize treatment of cancer and other diseases. We have 3D printers that can turn out replacement blood vessels and liver cells and heart valves. Medicine has changed, and it is constantly changing, and we have to get Washington out of the way, stop its micromanagement so that we can have an explosion of dynamic response to the great challenges that we face to turn them into opportunities not just for our better health but also for economic progress for all of us.
I believe, as I hope you do, that lives are saved by bold and courageous innovation and that we have a moral obligation to make sure Washington doesn’t get in that way. If we rely on the regulators of Washington, DC to decide what kind of healthcare we should get we will continue to get a lot of frustration, higher costs, and a lot more complexity than what we need. Or worse, look at the VA scandal that is taking place throughout our country, the VA hospitals. President Obama and many of the left have used the VA hospital system as a model for government controlled healthcare, bragging about how great it is. Well, the delays and deception speak for themselves and we’ve been warned. If that’s what the best that Washington can do I think we need to move in a different direction.
We need to unleash the power of millions of Americans, of doctors, of nurses, of entrepreneurs who are inventing the future of healthcare. Advanced screenings and medical tests that require only a stick of your finger for high risk populations. Personalized therapies for seniors who live far away from major hospitals. Genomic medicine so treatments match each person’s physiology. An app on your smart phone that calls a doctor to your front door just as it does for a car to come to pick you up. New devices that can mimic what our body was designed to do. I want all of us to embrace this change so that we can finally answer these questions with confidence. Did the patient get the care he or she needed? Did her health improve? Was there a more efficient and affordable way to get to the best result?
My plan therefore focuses on five key steps. First, as I said we’ll repeal Obamacare. That means all of its mandates, it penalties, new spending, new taxes, the arbitrary picking and choosing of the parts of the law that are implemented and the ones that don’t. All of that goes away, especially the new taxes on medical devices, drugs, and insurance all of which that drive up the health the cost of healthcare for middle income Americans. Second, instead of punishing innovation we’ll double down on it. My plan would aggressively support groundbreaking work at the NIH and our country’s finest researchers as they find new treatments and new cures. If we started from scratch, if we didn’t have a system of how we allocate the resources for the, the curing of diseases, the research that goes on and if we started from scratch with the FDA I can promise you it would be a less costly system that would take a lot less time and it would be more strategic in its efforts. And that’s what we need to do.
We need to rebut the, the strategy for health E-records and make medical records, record keeping more efficient, more shareable and more secure. The President had a golden opportunity to be able to do this but the simple fact is that the information technology funding through the stimulus was not, was not focused on creating a shared platform from all of us to benefit, and so we have huge complexity in information technology and that information is, is not protected nor is it shared. We need to accelerate the FDA process of drug and device approval so that potentially life-saving medications for cancer, Alzheimer’s, and other major killers can reach patients more safely and quickly.
I believe we need to create a consensus as, as we did in the 1960s when we, when John F. Kennedy suggested we, we launch a man to the moon we do that as an aspirational goal. I think we need to do the same thing as we create an aspirational goal to, to investigate and explore the brain. Think of all the challenges that exist in our communities today because we lag behind on understanding how the brain operates. Autism, Alzheimer’s, mental illness all of these challenges that play out in our society. A great country like ours with an abundance of resources like ours if we were strategic in our approach rather than viewing all this kind of as a trough and everybody just kind of tries to get to the front of the, you know, the high grade slop in the front of the trough, that’s not how it should work. We should be significantly more aspirational and strategic about how we go about doing this.
Innovation led by the private sector will be the center of everything we do because that’s the only way we can get better care at lower costs. We need to fix where the government is holding back innovative healthcare and we also need to have more innovative ways to pay for healthcare. Therefore, we would give people more control over their healthcare dollars. In my plan we would propose tax credits to those without employer coverage so that they could pay for portable and secure insurance that provides preventative care and also provides comprehensive coverage for major medical events. This will help middle class households who currently don’t qualify for the Obamacare subsidies and have been slammed by higher premiums brought about by Obamacare.
We would make it easier for small businesses to help their employees get coverage. Today as a small business person it’s either or. Either you provide insurance for your, for your employees or you don’t. A better approach perhaps would be to make it easier for lower cost insurance for small businesses to provide care, but if they wanted to provide support for individuals that wanted to get their own care in a less mandated form of, of access to care they should have that right to do and that, that should be a tax write-off for them. Many people are frustrated with the higher deductible plans and we’ll give them support they need by making it easier to save tax free for their out of pocket healthcare costs and copays such as copays in over the counter medications.
This system would work far better. Name a system where when you don’t have the consumer actually be engaged in making decisions you get a good result. That’s not how it works. The best system is one where people are totally engaged. Where we have transparent information for them to make decisions for themselves and where their focus where there’s support for them to be able to have the kind of insurance that will allow them to, to, to grow and prosper along with a health savings account so that they’re rewarded for healthy lifestyle decisions as they go forward. Whatever they don’t spend they should be able to save, and we’ll give them real transparency to decide which healthcare provider will provide the best value.
By giving individuals more control over their healthcare dollars healthcare providers are going to be more accountable for results and they’re gonna really compete to design the new ways to deliver care. This will require some major changes on how we regulate health insurance. States rather than Washington, DC are much better equipped to set the standards for health insurance. So here’s what I propose. We will open up state insurance markets to much broader competition and choice. Right now Obamacare locks in a handful of small handful of expensive one size fits all mandated policies engineered in Washington, DC. We need to break up the insurance monopolies and let people buy health insurance designed for what they actually want.
For example, an individual who may want to but a high deductible plan for the most, you know, for unexpected events the true form of insurance that, that should be the norm, but maybe they would want also have one that adds preventive care and diabetes management with, with no cost sharing at all. Or physicians may want to develop a plan that uses precision medicine to identify and cure one’s cancer. The possibilities for innovation are endless if we just trust the marketplace to do what it does so well. If people are informed and they make decisions based on the proper information that they have that the system is much more transparent the providers of insurance and the providers of care will respond with significant amount of innovation. Plans to protect you in case you get sick and plans with a focus on certain conditions such as heart disease would become the norm. Plans that are perfect for different stages of life whether people are single or whether they have a family or whether they’re retired.
And let me be clear about this. Everybody will have access to the tax credits that help them buy insurance that protects them from losing their life savings from major medical events. That should be the, the national focus. Making sure that people have catastrophic coverage so that their lives are not turned upside down by an adverse event that could have real devastation for their family. Whatever else people want insurance to cover they’ll be able to buy that, and we won’t force people to buy coverage they don’t want either because they don’t need it or it violates their conscience. And frankly, that’s one of the most egregious parts of Obamacare. The idea that you’re forced to do things against your own conscience and we would get rid of that.
There are certain things that we will ensure. We will expect that vulnerable Americans, regardless of how much money they make get the care and outcomes they deserve. Hillary Clinton says that that will happen under Medicaid. Let me tell you something. I was Governor of the State of Florida, I think we had the fourth largest Medicaid plan. And I can just promise you that states are extraordinarily frustrated with the federal state partnership that is Medicaid. And spending more through a broken insurance system is not the answer to this. Let’s try a new approach. Let’s let the states have the power to create a safety net we need for the 21st Century and hold them accountable for the results they achieve. If we took the money that goes right now to Medicaid and take the subsidies on Obamacare and put SCHIP in there in the mix and allowed states to innovate with certain outcome criteria I can promise you we would get a better result.
And you know why I know that? Because I had a chance to do a version of that when I was Governor of the State of Florida with our Medicaid plan. We had a pilot program in Fort Lauderdale and Jacksonville and in fact it was the 25th largest Medicaid plan and we created tiered premiums where Medicaid beneficiaries were given choice counseling. Where we empowered them to make choices. This notion that people living in poverty don’t know what’s right for their families we better start rejecting that out of hand. Whether it’s healthcare or education or what’s right for their families or the safety of their neighborhoods, America doesn’t do this right. This top down belief that some, some people are smart and some people aren’t I reject it and I hope you do as well. A Medicaid plan that empowers people to make decisions for themselves will get a far better result.
Imagine a system which is what we had in Florida where you had choice counseling, where you were awarded the proper making healthy lifestyle decisions, by allowing people to have more money to make healthy lifestyle decisions the next year. Where, where there’s competition, where there’s choices, where people pick the plan for them. Maybe they had a child that had asthma. You had a higher premium based on the actuarial cost of the Medicaid program for those types of beneficiaries. They’re empowered to make more choices because they got more for the, for the premium dollars that they had. A system that is focused on people rather than on government will yield a far better result.
And the net result of this was we did this at a lower cost than the old Medicaid plan. We did it at higher quality and Medicaid beneficiaries based on outside observations and studies suggested that it was far better for them. Why not empower people when we have a chance? And I believe the states are the place where this will happen. Washington has had its, had its day. It’s had its chance to do these things and it has failed us miserably. Try to get any change in a Medicaid program with Washington, DC it nearly takes an act of God. We need to liberate our country to be able to from the bottom up begin to solve these problems in a better way.
I won’t except the strongman argument from the other side that they’ve been making that the opposite of Obamacare is no care. There is a better way and it doesn’t mean going back to the way things used to be. We need a system that doesn’t just address the changes in healthcare but also one that meets the needs for our economy. As you may know my aspiration is that this country should grow at four percent per year as far as the eye can see. If we were doing that I can promise you that the demands on government would subside. There would be a lot more people in the private insurance market working for companies that would be able to increase their pay instead of having to slough off their healthcare costs. The greatest suppression of wages today is Obamacare and a healthcare system that existed prior to Obamacare. It is not working. More and more of the costs are associated are put on the backs of employees and take home pay has declined.
We’re in the sixth year of a recovery and disposable income today is 2,000 plus dollars less than it was the day recovery started. The healthcare costs are part of this and moving to a different system would make it work. According to the nonpartisan congressional budget office repealing Obamacare would increase GDP growth by .7, seven-tenths of one percent over five years which is a big part. Not the only part, but a big part of reaching the goal of four percent growth instead of this new normal of two percent growth. Repealing Obamacare alone would increase the numbers of hours worked and add the equivalent of four million full-time equivalent jobs to our economy. There are a lot of people working part-time, six-and-a-half million people. They want to work full-time but they’re stuck in a system because of these rules having these adverse incomes that wither weren’t anticipated or people didn’t care.
No matter how you earn a living my plan will give American people control over their healthcare. And I reject the arguments you hear from the progressive left whether it’s Senator Sanders or Hillary Clinton or the Obama administration that Americans aren’t equipped to make these decisions and that government has to do the work for them. That is not the American way. If you inform people and empower them with the right, right information in a much more transparent system you can, I can promise you that people are smart. They will act on their self-interest which is lower cost at a higher quality for their families.
I'm not afraid of giving people information about their healthcare and how much it costs and how they can save. You know why? Because I got to do that as Governor of the State of Florida as well. We were the first state to put online all of the costs of procedures for hospitals. Hospitals at first thought this was kind of a radical idea. They didn’t like it. But then they realized why shouldn’t we do this? Because then they started offering care and promoting the fact that they had better outcomes at lower costs. Think about every aspect of our economy. I mean, think about this. Is this the only place in the economy where low cost and higher quality is assumed to be impossible to achieve? The rest of the economy does this daily. Almost every aspect of our life the push is to lower cost and through innovation create more abundance, more prosperity, more possibilities, more choices, higher quality. Healthcare needs to get to that as well. It will there will be an explosion of benefits for consumers and for people in terms of our economy and better health if we, if we tear down the barriers that, that are so commonsensical in every other aspect of our, of our economy and economic life in this country for some odd reason people just can’t see how lower costs can improve if you do it the right way quality where we prevent illness and we create a better chance for people to, to live a life of purpose and meaning.
That’s how healthcare could work, but it’s gonna require the kind of leadership we need to fix these big complex things. Look, whether it’s regulation in general or taxes or embracing the energy revolution in our midst, or reforming our higher education system where we have an explosion of debt and people young people particularly stuck with recourse debt, and we haven’t reformed the higher education system to make sure that degrees are obtained in a way that allows young people to begin their journey in life. All of these things are broken right now because we haven’t had the leadership in Washington to bring people together to fix them. And I believe if we do it in healthcare this will be the most exciting time to be alive in this world. This is an essential element of what the next President has to do. I believe I have the skills to do it. I have the zeal for reform I can promise you that. And I believe that if we get this right as I said we’ll have our grandchildren living way beyond 100, we’ll be hopefully up in heaven at least my age. But we’ll have, we’ll have a society that will lead the world. A society that will continue to be the envy of this entire planet. I think it’s worth fighting for. I hope you do as well. Thank you all very much.
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