SUGGESTED FIXES TO HEALTH CARE

Nothing is more important than the health and security of the people government serves. So why are we still debating on common-sense healthcare and insurance solutions?

The Healthcare Solution: I support Medicare for All but since it will take years to pass and implement, we must immediately amend the ACA to guarantee healthcare for everyone, and force prices down while working towards Implementing Medicare for All or Universal Coverage.

A deeper explanation follows the 9 objectives listed below.

1. Reduce cost of prescription drugs; (One of the three causes of increasing premiums)
2. Reduce hospital rates and charges for hospital care; (One of three causes of increasing premiums)
3. Initiate a public option to allow people and employers to buy into Medicare. This will force competition into the marketplace and reduce risk and cost of private insurance)
4. Explore reducing the age to enter Medicare to 50 years old. (Will reduce risk and cost of private insurance)
5. Prohibit separate pools between employer sponsored insurance and private pay insurance. (This will increase risk sharing and reduce prices)
6. Fund and utilize the “risk corridor” or “cost sharing”of the ACA. (One of the three causes of increasing premiums)
7. Require the disclosure of the contractual prices between the insurance companies and service providers. (This will increase true choice, create competition, and reduce costs)
8. Allow insurance companies to sell across state lines, as long as the policy is compliant with the ACA and the market state’s requirements.(This will increase competition)
9. Increase capacity for medical services through medical schools, physicians assistants, nurse practitioners, nurses, and all other medical personal. (This will increase capacity and ability to serve the over 300 million American’s medical needs and prepare for a new future, modern, cost effective, and affordable health care system.)

(The above will give us immediate relief to insurance prices, healthcare costs, and co-pays. A vast majority of Americans want a Medicare for All or single payer, and I support these ideas. The implementation of single payer or Medicare for All will take many years to implement. The  above fixes to the ACA will give us immediate relief while single payer or Medicare for All is implemented, once it is passed. (The above will fit perfect on top of the ACA and implemented within a year.)

See Below for a more in depth explanation.

1. Bring down the cost of prescription drugs by either the Federal Government negotiating prices, imposing the pricing negotiated for the VA and/or medicare, capping profits, capping amount that can be charged for drugs, requiring that they can not charge more then they charge for the same drug in other countries, or any combination thereof. Also permit the importation of prescription drugs. (This will spur competition, using an argument form the right.) The drug companies must be reigned in and markups on drugs controlled. This will also spur innovation for new drugs which has been stagnant for some time. The five largest pharmaceutical companies spent about 5.2 billion dollars on advertising in 2015. That is an indication of the excess money we pay for prescription drugs. That is more then they spent on research and development. Drug prices contribute a large amount to the cost of health insurance and the cost of medicare.

2.  Cap hospital charges and rates according to Medicare rates in the Medicare region the facility is in. At the very least, nonprofit hospitals that avoid paying income taxes due to their non0profit status, must charge no more then Medicare pricing and treat Medicaid patients. If they want to charge more then Medicare rates or refuse Medicaid, they can hardly be called nonprofit. That tax revenue can be used to strengthen Medicare, Medicaid and aid in the pricing of a Public Option. Currently hospitals charge multiples of Medicare rates, sometimes as high as 10 times higher. CT Scans cost at some hospitals $8000 which is much more then local private CT companies. Hospitals and other facilities also charge a “facility fee” which needs to be evaluated. The current system allows non-profit hospitals to use their huge tax savings to buy up more hospitals and doctor practices, giving them more negotiating power over insurance companies and allowing them to demand such high multiples. This cost must be controlled or we will never get health insurance costs down.

3.  Initiate a public option to allow people to BUY into or PURCHASE medicare. The government will subsidize the poor as is done through the ACA. This has several benefits to everyone. First it gives an opportunity for those older and with preexisting conditions to buy insurance without having to pay for the profit of the insurance companies, and will lower insurance costs. Secondly, it will remove many older and sicker people to Medicare, lessening the cost burden to the insurance market, it will also spur COMPETITION between the insurance industry and Medicare, and according to the Republican Leadership, Competition is good for insurance prices. Medicare competition is necessary to bring competition to the market place. Policies are priced based on a number of factors including actuarial tables in the specific market. I believe that even with 100 insurance companies pricing in the same market there will be no added competition. Thirdly, open the public option to employers which would allow them to save money on providing healthcare to their employees. This will save them money and the employees money.

Medicare is self sustaining through FICA, and with the decrease in drug prices, hospital costs, and the added people buying into Medicare, including healthy younger people, it can survive in perpetuity. I am also looking into ending Medicaid and rolling it into the Medicare option. The Feds already give the states money for the program and the states also contribute but the reimbursement rate for doctors is horrible which is why many doctors do not take Medicaid. This model does not make sense to me and harms the very poor which is mostly women and children. Children should have the best possible healthcare possible. They are our future.

4.  Currently most insurance companies pool employer sponsored health insurance separately from private pay and ACA market place plan. The employer insurance pools generally contain the healthiest individuals. I believe eliminating the separate indemnity pools and combining them, will lower overall insurance costs because there will no longer be a pool with healthy workers and a pool of the rest. Combining them will allow proper risk sharing, which is after all, what health insurance is all about, risk spreading.

5.  Repeal Senator Rubio’s legislation that required the Risk Corridor be budget neutral. Fund and reimburse the insurance companies for their losses pursuant to the ACA Risk corridor provision. Rubio’s legislation prevented the insurance companies from being reimbursed for their losses because of market uncertainty. Here is a great article about the risk corridor, what it is, how the republicans screwed the insurance companies to force higher prices and place us all at risk for political gain. (It was timed perfectly to have the greatest effect during the 2016 election.

6.  Require the disclosure of the contractual prices between the insurance companies and service providers. The anti ACA folks claim that people need to have skin in the game and pay for some of their care, above insurance policy costs. They like deductibles and cost sharing (co-pays) of treatments. They quote again that this cost sharing brings competition to the marketplace. They believe that people will shop for the best price. This is nonsense. I have never heard of  a person suffering from a heart attack, stroke, car accident, or whatever asking to be taken to the least expensive hospital. I have never heard of anyone at the hospital refusing the $8000 CT scan before surgery because r*** radiology down the street is less expensive.

The competition argument from the anti ACA people does have some validity here. People with health insurance usually have a primary care provider and they shop for insurance, starting with which plan that primary care provider is in. However, there is no competition between plans or insurance carriers because we have no idea what anything will cost until after we buy the plan, first receive the service, and get the bill. If we know what the cost will be for a specific service, from the specific provider, consumers can then shop for the least expensive policy for that provider or service. For example, if I go to Dr. Smith and one policy has a 10% co-pay and and another policy has a 20% co-pay for the same procedure from Dr. Smith, I need to know what the negotiated price to me will be so I can figure out which one is a better deal. Mathematically, just because one co-pay is less then another, does not mean I will pay less at the payment window. We should have access to all negotiated prices so we know what our primary care provider will cost us under one plan vs under a different plan. The current system is the equivalent of Wal-Mart selling a  TV with 10% off and Target selling the exact same one at 20% off. How are we supposed to know which of the two stores are giving us the best price without knowing the cost of the TV before the discount.

7.  I do not believe the selling of insurance policies across state lines will increase competition or lower costs. Insurance prices are based on the market of where the policy is being sold. But, maybe with more companies competing with one another, AND the disclosure of all negotiated rates, will allow consumers to pick the one that is the least costly to them.

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