Libertarian presidential nominee; former Republican NM Governor
US needs free market approach to health care, not government
Donald Trump: ObamaCare is a disaster. We have to repeal it, and replace it with something less expensive. And something that works. We have to get rid of the lines around the state, where we stop insurance companies from competing.
We want competition.
Gary Johnson: Bring competition to healthcare! A free market approach is needed, and recognize that healthcare is far removed from the free market.
Source: Johnson Twitter posts on Second 2016 Presidential Debate
, Oct 9, 2016
Let states experiment with Medicare & Medicaid rules
Q: You're going to submit a balanced budget--what would you cut to do that?
JOHNSON: Well, you've got to address the entitlements. You can't do it if you don't address the entitlements.
JOHNSON: When it comes to Medicaid and Medicare,
these services need to devolve to the states, something that is not currently happening. As the governor of New Mexico, if the federal government would have block-granted the state of New Mexico a fixed amount of money,
I would have been able to draw new lines of eligibility, there would have been a health safety net; that those that were in need would not have gone without those needs being met. I think the Federal government, though, is incapable of drawing those
new lines of eligibility, and I always say with 50 laboratories of innovation and best practice we will actually have some best practice that will get emulated, we'll also have some horrible failure that will get avoided.
Run Medicare and Medicaid via states and municipalities
Q: The working poor--how are they going to get health care under your plan to reduce eligibility for Medicare and Medicaid?
JOHNSON: Well, you're assuming that health care has always existed. It's never been an issue of people receiving healthcare.
It's been an issue of who pays for it.
Q: Who would pay for it if they're not eligible?
JOHNSON: Well, it ends up to be municipal, something that local communities deal with, and states do deal with, and then of course there's the federal money
match on all this. But we've had this escalation of increasing Medicaid benefits for year after year after year, [to the level of] 300% of poverty. Well, just dial back that eligibility.
Q: But if local communities or states are paying for it,
government spending hasn't gone down, just federal government spending has gone down.
JOHNSON: Federal government spending would have to go down.
Q: But total government spending would not have gone down.
Free market reduces prices with places like "Stitches R Us"
Q: Why is it better, under your healthcare plan run by the states, if you're still spending 22% of GDP--
JOHNSON: Well, if you're talking about health care, the reforms needed are genuine free-market approaches to healthcare. I reject the notion that
we have insurance to cover ourselves for ongoing medical need. It's really crazy. In a free-market approach to health care, we would have insurance to cover ourselves for catastrophic injury and illness, and we would pay as you go in a system that
I'm going to guess would cost about 1/5 of what it costs right now. It would be cash and carry. It would be "Stitches R Us", it would be "Gallbladders R Us", "X-rays R Us". It would be advertised pricing. It would be advertised outcomes.
Something that today, you go to the doctor, you have no idea what it's going to cost--you have no idea what the outcome's going to be, and when you see the bill you know that nobody's really going to pay the amount that's on that bill.
Catastrophic insurance ok; then free-market for the rest
Q: Your position is to replace government-run health insurance and medical care with a very competitive free-market system, But is it really a Libertarian principle that, for someone who chose not to have insurance, society should say that "he's made
a choice, bear the consequences," and he should be allowed to die?
JOHNSON: There should be a safety net out there regarding health care, and in no way are we saying that the safety net should be eliminated.
At the end of the day, I'm going to sign onto any initiatives, really, that bring a free-market approach to health care. We would have insurance to cover ourselves for catastrophic injury and illness. And if we could bring genuine competition to
health care, you would have Stitches-R-Us; you would have advertised pricing with published outcomes. Something that right now, when any of us go to the doctor, we have no idea what it's going to cost, we have no idea what the outcome is going to be
Assisted suicide acceptable after psychological examination
Q: Should terminally ill patients be allowed to end their lives via assisted suicide?
Hillary Clinton: I don't know the answer to that. I have a great deal of sympathy for people who are in difficult end-of-life situations.
I've gone to friends who have been in great pain and suffering at the end of their lives. I've never been personally confronted with it but I know it's a terribly difficult decision that should never be forced upon anyone.
So with appropriate safeguards and informed decision-making, I think it's an appropriate right.
Gary Johnson's answer:
Yes, but only after a psychological examination to show they fully understand this choice
Donald Trump has not stated a position on this issue
ObamaCare's promise of lower cost simply isn't happening
I applaud the President's optimism. I too am an optimist. But I have a real problem with basing that optimism on what government has done over the past 7 years and what President Obama wants it to do in the future.
He talks about medical advances, after having done everything in his power to kill medical innovation with new taxes and layers of bureaucracy.
His signature promise of better care and lower cost simply isn't happening.
I'm optimistic, but not because of anything the government is going to do for us. I'm optimistic because it is clear
America is tired of too much government and too little freedom, and appears poised to demand change--a different kind of change than we have gotten over the past 7 years.
Government has never managed any segment of the economy successfully. To expect that it can do so for health care--one of the largest segments--is insanity. Nowhere is it more important that the best possible services and products be available
at affordable prices than in the area of health. Government simply cannot fulfill that mission. Rather, real competition, freedom to innovate and a working marketplace will provide Americans with the health care they want and will demand.
To the extent that we, as a society, want to help those who are truly in need, that help can best be provided by the states--with any federal assistance coming in the form of block grants to
be applied to best practices, innovative programs and the most efficient delivery of services.
Q: You told the Wall Street Journal last year that you support means testing for Medicare and Social Security, for which you said you would raise the eligibility age. In what specific ways would you cut entitlement programs to balance the budget?
A: 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% 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.
ObamaCare is unconstitutional; so is Bush's Medicare Rx plan
Q: Will you issue an executive order to repeal ObamaCare as unconstitutional?
A: 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.
Source: Interview by Scott Holleran on scottholleran.com blog
, Aug 21, 2011
Salud!: managed care for Medicaid recipients
Governor Johnson has an excellent record of holding down the exploding growth of entitlement programs that now cripple state budgets. As Governor, Johnson presided over the beginning of managed care for Medicaid recipients in
New Mexico and pushed for speedy implementation. The managed care program (known as Salud!) replaces fee-for service and covers approximately two-thirds of available services under Medicaid.
Salud! has generally been described as operating with "significant savings to both the State and Federal governments," when compared to fee-for-service.
In 2002, Johnson proposed limiting eligibility for Medicaid from 235% of the federal poverty level
Unlike some of the other Republican candidates for President, Gary Johnson never raised the cigarette tax. While the tax on cigarettes has little relevance to economic growth, the fact that he held the line on such taxes demonstrates how strongly he
opposes tax hikes. In 1999, he vetoed a 12-cent-a-pack cigarette tax hike --not because he liked smoking, he says, but because he opposes all tax hikes. New Mexico's cigarette tax rate stayed the same from 1995 to 2003.
Source: Club for Growth 2012 Presidential White Paper #9: Johnson
, Jul 21, 2011
Cut Medicare/Medicaid by 43%, as part of $1.675 trillion cut
Q: How do you stop the deficits and out of control spending?
A: I'm under the belief that we are on the verge of a financial collapse. And we have no ability to repay $14 trillion in debt if we're racking up
$1.6 trillion in deficit spending in deficit spending this year, and the years looking ahead. Look, we're not going to pay back $14 trillion in debt. We have to embark on balancing the federal budget tomorrow.
A: Well, cutting $1.675 trillion from the federal government. You got to start out by talking about Medicare and Medicaid by 43 percent. They could block grant the states, 50 laboratories of innovation. 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're be failure. States would avoid the failure.
Repeal ObamaCare & failed Medicare prescription drug benefit
Government spends too much because it does too much. Unchecked deficits are the single greatest threat to our national security. Unless we take significant steps soon, our federal debt will equal the entire economic production of the United States.
We should start by reassessing the role of the federal government, and always asking the question: Should the government be doing this in the first place? We must act now to enact responsible entitlement reform:
Identify and implement common-sense
cost savings to place Medicare on a path toward long-term solvency.
Block grant Medicare and Medicaid funds to the states, allowing them to innovate, find efficiencies and provide better service at lower cost.
Repeal ObamaCare, as well as the
failed Medicare prescription drug benefit.
Fix Social Security by changing the escalator from being based on wage growth to inflation. It's time for Social Security to reflect today's realities without breaking trust with those soon to retire.
Vetoed mental illness coverage parity with physical illness
The National Alliance for the Mentally Ill (NAMI) blasted New Mexico Governor Gary Johnson for his veto of HB 315, which would have established a pilot program for state employees providing coverage for mental illnesses equal to that offered for other
physical illnesses. NAMI's Executive Director said, "By caving in to business's fear that the pilot would prove parity is indeed cost effective, he put people with severe mental illnesses and their families last, even as state & federal lawmakers around
the country move in the direction of equality for people with mental illness. Governor Johnson's actions are behind the times."
Senator Pete Domenici (R-NM) has been "a patron saint to the millions of Americans suffering from mental illness."
Paving the way nationally toward ending decades of unfair insurance discrimination, Senator Domenici and Senator Paul Wellstone (D-MN), successfully sponsored landmark legislation, the Mental Health Parity Act, which took effect on January 1, 1998.
Source: NAMI press release, "Veto Of Insurance Parity Bill"
, Mar 12, 1998
No federal pre-emption of employee health plan regulation.
Johnson adopted the National Governors Association position paper:
In 1999, 42.6 million Americans did not have health insurance. All states have been fervently working to reduce the number of uninsured Americans, to make health insurance more affordable and secure, and to provide quality health care at a reasonable cost to the uninsured. However, the federal government has also expressed an interest in this issue. Any action taken at the federal level could have serious implications for traditional state authority to regulate the health insurance industry and protect consumers.
Although the Governors are extremely sensitive to the concerns of large multi-state employers, the fact remains that the complete federal preemption of state laws relating to employee health plans in the Employment Retirement Income Security Act (ERISA) is the greatest single barrier to many state reform and patient protection initiatives.
The Governors support efforts designed to enable small employers to join together to participate more effectively in the health insurance market. In fact, Governors have taken the lead in facilitating the development of such partnerships and alliances. However, these partnerships must be carefully structured and regulated by state agencies in order to protect consumers and small businesses from fraud and abuse and underinsurance. NGA opposes attempts to expand federal authority under ERISA. The Governors have identified the prevention of such federal legislation in the 107th Congress as a top legislative priority.
States have the primary responsibility for health insurance regulation. Across the nation, Governors are working to protect consumers and patients and to properly regulate the complicated health insurance industry.
Source: National Governors Association "Issues / Positions" 01-NGA13 on Oct 5, 2001
More federal funding for rural health services.
Johnson signed the Western Governors' Association resolution:
Western Governors want rural areas to have an adequate and able workforce to deliver needed health care services. The governors call on the federal government to provide necessary funding for programs such as the National Health Service Corps (NHSC) that have a state-based component, and the Health Professions programs that help health professionals serve in rural and frontier areas.
Western Governors believe that rural health care providers should be paid fairly by Medicare in order to ensure access to health care for rural citizens. The governors encourage the federal government to take further steps to ensure equity in Medicare reimbursement for urban and rural areas.
Alaska, Hawaii, America Samoa, the Northern Mariana Islands and Guam face extraordinary geographic barriers in providing healthcare services and they should be designated for special consideration and adequate funding to overcome their frontier barriers.
Federal programs like the Rural Health Outreach Grants and the Rural Hospital Flexibility program need to continue to provide funds to states and communities to experiment with new programs, integration of services and coalition building to develop new types of providers, facilities, and services.
Western Governors believe in strengthening the existing health care system. Support for home health agencies, rural health clinics, public health nursing and critical access hospitals are partial solutions.
Western Governors support the elimination of barriers to the use of telemedicine as outlined in the WGAís 1998 report. In particular, we request that the federal efforts to increase reimbursement for telemedicine consultations, to protect the privacy of patient-identifiable medical information and to support rural health provider telecommunication costs with universal service funds continue.
Source: WGA Policy Resolution 01 - 06: Rural Health Improvements 01-WGA06 on Aug 14, 2001
Protect state tobacco settlement funds from federal seizure.
Johnson adopted a letter to Congressional leaders from 53 Governors:
As you know, preserving and protecting the state tobacco settlement funds is the nationís Governorsí highest priority. We strongly urge you to reach final agreement and pass the conference report on the emergency supplemental appropriations bill soon, and to retain the Senate provision that protects our settlement funds from federal seizure.
Many of our state legislatures are currently in session, and some have already completed work on their budgets. Therefore, it is critical that conferees reach agreement quickly on this issue. Governors are unified in their commitment to ensuring that the funds remain in the states and that there be no restrictions on statesí ability to tailor spending to meet the needs of their citizens.
We offer our strongest support for conferees to recede to the Senate version of the bill containing the Hutchison/Graham bipartisan tobacco recoupment protection legislation.
Source: National Governor's Association letter to Congress 99-NGA31 on Apr 14, 1999