Editor’s Note: This is an edited excerpt, comprising the Introduction and Conclusion, from a longer essay by Mr. Atlas. Titled ‘The Costs Of Regulation And Centralization In Health Care,' it is published by the Hoover Institution as part of a new initiative, "Socialism and Free-Market Capitalism: The Human Prosperity Project."
The overall goal of US health care reform is to broaden access for all Americans to high-quality medical care at lower cost. In response to a large uninsured population and increasing health care costs, the Affordable Care Act (ACA, or “Obamacare”) aimed first and foremost to increase the percentage of Americans with health insurance. It did so by broadening government insurance eligibility, adding extensive regulations and subsidies to health care delivery and payment, and imposing dozens of new taxes. The ACA was projected to spend approximately $2 trillion over the first decade on its two central components: expanding government insurance and subsidizing heavily regulated private insurance.
Through its extensive regulations on private insurance, including coverage mandates, payout requirements, co-payment limits, premium subsidies, and restrictions on medical savings accounts, the ACA counterproductively encouraged more widespread adoption of bloated insurance and furthered the construct that insurance should minimize out-of-pocket payment for all medical care. Patients in such plans do not perceive themselves as paying for these services, and neither do physicians and other providers. Because patients have little incentive to consider value, prices as well as quality indicators, such as doctor qualifications or hospital experience, remain invisible, and providers do not need to compete. The natural results are overuse of health care services and unrestrained costs.
In response to the failures of the ACA, superimposed on decades of misguided incentives in the system and the considerable health care challenges facing the country, US voters at the time of this writing are being presented with two fundamentally different visions of health care reform: (1) a single-payer, government-centralized system, including Medicare for All, the extreme model of government regulation and authority over health care and insurance, which is intended to broaden health care availability to everyone while eliminating patient concern for price; or (2) a competitive, consumer-driven system based on removing regulations that shield patients from considering price, increasing competition among providers, and empowering patients with control of the money. This model is intended to incentivize patients to consider price and value, in order to reduce the costs of medical care while enhancing its value, thereby providing broader availability of high-quality care.
Outside a discussion of the role of private versus public health insurance are two realities. First, America’s main government insurance programs, Medicare and Medicaid, are already unsustainable without reforms. The 2019 Medicare Trustees report projects that the Hospitalization Insurance Trust Fund will face depletion in 2026. Most hospitals, nursing facilities, and in-home providers lose money per Medicare patient. Dire warnings about the closure of hospitals and care provider practices are already projected by the Centers for Medicare and Medicaid due to the continued payment for services by government insurance below the cost of delivery of those services. Regardless of trust fund depletion, Medicare and Medicaid must compete with other spending in the federal budget. America’s national health expenditures now total more than $3.8 trillion per year, or 17.8 percent of gross domestic product (GDP), and they are projected to reach 19.4 percent of GDP by 2027. In 1965, at the start of Medicare, workers paying taxes for the program numbered 4.6 per beneficiary; that number will decline to 2.3 in 2030 with the aging of the baby boomer generation. Unless the current system is reformed, federal expenditures for health care and social security are projected to consume all federal revenues by 2049, eliminating the capacity for national defense, interest on the national debt, or any other domestic program.
Second, beyond the growing burden from lifestyle-induced diseases, including obesity and smoking, that will require medical care at an unprecedented level, America’s aging population means more heart disease, cancer, stroke, and dementia—diseases that depend most on specialists, complex technology, and innovative drugs for diagnosis and treatment. The current trajectory of the system is fiscally unsustainable, and millions are already excluded from the excellence of America’s medical care.
In most nations, heavy regulation of the supply of health care goods and services care is coupled with marked centralization of payment for medical care. The United States has a far less centralized but still highly regulated system in which health expenditures are roughly equal from public and private insurance. The system is characterized by its unique private components: more than 200 million Americans, including most seniors on Medicare, use private insurance. The US system is the world’s most effective by literature-based, objective measures of access, quality, and innovation, but US health care demands reform. Health care costs are high and increasing, and the projected demand for medical care by an aging population and the future burden of lifestyle-related disease threaten the sustainability of the system.
Although the regulatory expansion under the Affordable Care Act reduced the uninsured population, it generated increased private insurance premiums, a withdrawal of insurers from the market, and sector-wide consolidation that is historically associated with higher prices and reduced choices of medical care. In its wake, American voters are now presented with two fundamentally different visions for reform that have a diametrically opposed reliance on regulation and centralization: (1) the Democrats’ single-payer proposals, including Medicare-for-All, based on the most extreme level of government regulation and authority over health care and health insurance; or (2) the Trump administration’s consumer-driven system that relies on strategic deregulation to increase market-based competition among providers and empowering patients with control of the money. Both pathways are intended to contain overall expenditures on health care and broaden access.
Intuitively, a single-payer model of health care represents a simplification, but the reality is that such centralized systems impose overwhelming restrictions on both demand and supply. Government-centralized single-payer systems actively hold down health care expenditures mainly by sweeping restrictions on the utilization and payment for medical procedures, drugs, and technology under the single authority of the central government. The overall costs of this false simplification are enormous, creating societal costs that extend beyond calculated tax payments that are required to support such a system.
The alternative approach involves rule elimination and decentralization, that is, strategic deregulation, to induce competition for value-seeking patients. Reducing the price of health care by competition, instead of more regulation, generates lower insurance premiums, reduces outlays from government programs, and broadens access to quality care. Broadly available options for cheaper, high-deductible coverage less burdened by regulations; markedly expanded health savings accounts; and tax reforms to unleash consumer power are keys to achieving price sensitivity for health care. Reforms to increase the supply of medical care by breaking down long-standing anti-consumer barriers to competition, such as archaic certificates‐of‐need for technology, unnecessary state‐based licensure of physicians, and overly regulated pathways to drug development, while facilitating transparency of price and quality among doctors and hospitals, would generate further competition and reduce the price of health care. Preliminary results from such deregulatory actions demonstrate promising results and offer an evidence-based context for the broader discussion of the role and reach of government regulation in socialism compared with free-market systems.
Obamacare may be weakened, but its chief designer, Ezekiel Emanuel, still wants to decide whether your life is worth living.
NBC News and MSNBC recently announced that Ezekiel Emanuel, the chief Obamacare architect and brother of President Obama chief of staff Rahm Emanuel, has been hired as a “medical contributor.” Presumptive Democrat presidential nominee Joe Biden has also tapped Emanuel as a health care advisor.
According to Yahoo News, he will co-host a four-part special on Lawrence O’Donnell’s “The Last Word” that will “examine the public health crisis from a variety of perspectives, including the governmental response, the strain on hospitals, the latest research into treatments and how the disease works, and the heroes — nurses, doctors and medical personnel — who are fighting COVID-19 on the front lines.” Emanuel recently told MSNBC the United States has “no choice” but to remain in lockdown for the next 18 months to fight the virus.
Now seems a good time to remember that Emanuel believes people — particularly the aged — who aren’t contributing materially to society should get out of the way for the benefit of the strong. It’s an argument that seems especially ironic at this time, given that President Trump is getting pounded by the left daily for purportedly putting the health of the economy over the well-being of the vulnerable.
Writing for The Atlantic back in 2014, Emanuel outlined the reasons he hopes to die at the age of 75. He wasn’t outright advocating euthanasia or assisted suicide, but stating his intention, when he reaches 75, to eschew any medical treatments designed to prolong his life — not only aggressive measures such as chemotherapy, but also treatments as basic as antibiotics.
His argument was a purely utilitarian one: by the time someone has reached 75, he is on the downhill slope — in mental acuity, creativity, physical strength, productivity, and ability to contribute materially to society. Rather than prolong a life that Emanuel deems of lesser quality and worth than it was at 20, 40, or 60, he plans to accelerate the arrival of death and, theoretically, compress the period of suffering that precedes death. He doesn’t want his children to go through a lengthy time of watching him decline and die, only to be left “with memories framed not by … vivacity but by … frailty.”
Shortly after Emanuel’s article was published, I wrote a response, “Why I Want to Live Long and Burden My Children,” arguing against his utilitarian view. The title was not ironic. I described the challenge of caring for my elderly mother in my home, noting that, while she wasn’t able to contribute in ways the world generally values, the “burden” of her presence was a blessing to my family in other ways, teaching us about humility, service, sacrifice, and the inherent value of life apart from its so-called usefulness.
Fast-forward five years. In January, Emanuel wrote a new article for The Atlantic in which he recounted the weeks leading up to and including his father’s recent death. After a fall, Emanuel’s 92-year-old father was diagnosed with an incurable brain tumor. Rather than seek treatment, the family decided to take him home to die in peace.
Emanuel uses the occasion of his father’s death to demonstrate the health system’s predisposition toward continuing pointless treatments rather than providing quality end-of-life care. He concludes, “A terminal diagnosis is inherently traumatic for patients and their families. My father’s experience at home before his death needs to become the standard of care. And not just for patients with pushy sons who have medical training and know how to speak with physicians, disconnect cardiac monitors, and firmly refuse the interventions that our health-care system is so predisposed to offer.”
It’s a worthwhile point. Like many, I can relate to Emanuel’s experience with his father. In 1994, my own father died of lung cancer, metastasized to his brain and liver. He previously had a leg amputated due to peripheral artery disease and was in a weakened state from that as well as from radiation for the cancer.
Once the cancer spread, the oncologist told my mom that the next step, chemotherapy, would be extremely hard on my father, with little chance of measurably extending his life. He said that, if the patient were his own father, he would not recommend it. My father, with my mother’s support, turned down further treatment.
My mother’s own end-of-life story is similar to that of Emanuel’s father. She died four years ago, after a fall followed by a hospitalization, complications, and, finally, hospice care. When it became clear that she was too tired to fight, we took her home to die in her own bed, surrounded by people who loved her.
So I am not arguing for doing anything and everything to prolong life when it’s clear that death is imminent. I am a Christian who believes that there comes a time to shift the focus from extending earthly life to preparing for the passage into eternal life.
But those looking to Emanuel for end-of-life guidance would do well to remember that he is an atheist who has not changed his view about how to approach questions of life, death, and patient care since he served as the primary designer of Obamacare. A review of his most recent interviews and writings on the topic reveals that he still holds to a utilitarian approach based on productivity and “quality” rather than one that has a high regard for all life, regardless of whether it is valued by others. In fact, he objects asmuch to the healthy senior citizen living it up in a Florida retirement community as to the one waiting to die in a nursing home because, in his view, neither is contributing meaningfully to society.
“Look at what most 82-year-olds are doing, even the ones who are mentally and physically functional,” he says. “The New York Times had this big story about the Fountain of Youth that was published just after my article. They went to some place in Arizona where they reported on this woman riding a motorcycle and this guy scuba diving, all in their 90s. Basically, those people are having fun. They’re not doing anything that is contributing new ideas, new contributions, or mentoring younger people. They are enjoying themselves. Which is great. But not if it is all of your life.”
The problem with judging the value of a life based on its “quality” or usefulness is determining who gets to decide. The child in the womb, the patient in a vegetative state, and the elderly person with dementia are not able to speak for themselves. They are weak and at the mercy of others who, however well-intentioned, cannot entirely ignore their own agendas.
Even those who are able to speak for themselves — whether healthy, disabled, or terminally ill — may be influenced by all manner of arguments based on quality, usefulness, or convenience because such arguments have been so pounded into our societal consciousness. But when we buy into them even a little bit, we unlock a door that is all too easy to throw wide open.
If we allow the child who is likely to have a low “quality” of life to be aborted at 3- or 6- or 9-months’ gestation, what is the problem with killing her, on that basis, right after birth — or even later? If an older person, whether ill or healthy, is no longer contributing what Emanuel deems to be “meaningful work,” why should the health care system help him keep going?
Then there’s that little issue of cost. Emanuel notes in his most recent article that it was much cheaper to take his father home than to continue pursuing treatment.
In a 2019 article for National Review, Wesley J. Smith cites a Journal of the American Medical Association editorial about the inevitability of health-care rationing. He notes that while the force of Obamacare has been “blunted,” the “overarching” plan of rationing is still in place, and voices like the New England Journal of Medicine continue to tout “quality of life” as one basis on which to do so.
I agree with Emanuel on one point: no matter what we do and how we try to escape death, it will come for each of us, and at some point, we have to come to terms with and prepare for it. But none of us is in a position to decide what makes a life worth living. To do so is the epitome of human arrogance. As Lutheran pastor Christopher Esget preached in a sermon before this year’s March for Life in Washington, D.C., “God makes, and we are made. He makes life, and we leave alive.”
Emanuel is now 13 years from the age that he said, in 2014, he wants to die. No doubt he considers that he is still contributing sufficiently to the universe to merit continued dependence on that universe’s resources. I wish he granted the same right of self-evaluation to everyone else, particularly as he positions himself as a voice of authority during a pandemic.
I also wish he understood that the God who created him, and who loves him whether he acknowledges it or not, has a much different gauge of his life’s value than its usefulness in this world.
By Wesley J. Smith • National Review
bamacare failed. There is no denying it anymore. The supposed “signature achievement” of the 44th president isn’t just opposed by Republicans. The Affordable Care Act has now been jilted also by many Democrats, who, like so modern-day Lotharios, have abandoned their once-burning ardor for state insurance exchanges to pursue “single-payer” health care.
Some readers are yelling, “That was the plan all along!” Yes, but the stew is not fully cooked. I doubt President Obama and the Pelosi Congress of 2009 and 2010 planned for their party to move so radically this soon. Oh well. With burning hatred for everything Trump as the accelerant — and with polling popularity of Bernie Sanders’s “Medicare-for-all” legislation of last year serving as a justification — much of the Democratic party now unapologetically embraces outright socialized medicine.
The newly filed 120-page “Medicare for All Act of 2019,” authored by Pramila Jayapal (D, Wash.), already has 106 co-sponsors — nearly half of the Democratic caucus — and it seeks to yank America hard toward the port side of the political spectrum. The bill — which resembles Medicaid more than it does Medicare — would transform our entire health-care system into an iron-fisted centralized technocracy, with government bureaucrats and bioethicists controlling virtually every aspect of American health care from the delivery of medical treatment, to the payment of doctors, to even, perhaps, the building of hospitals. It would obliterate the health-insurance industry and legalize government seizure of pharmaceutical manufacturers’ patents if they refuse to yield to government drug-price controls.
Here are some of the plan’s most destructive features:
It Would Drown the Country in Red Ink: True to its title, the bill promises comprehensive and encompassing “free” health care for everyone, including primary care, hospital and outpatient services, dental coverage, vision, audiology, women’s reproductive health services, long-term care, prescription drugs, mental-health and substance-abuse treatment, laboratory and diagnostic services, ambulatory services, the list goes on and on. Last year’s version of the plan authored by Bernie Sanders (I., Vt.) — which didn’t include coverage for dental and long-term care — was estimated to add $32 trillion to the budget over ten years. It is also not irrelevant that the current Medicare — which is far more limited — is scheduled to go broke in 2028.
Yes, There Would be Rationing: The bill creates a Physician Practice Review Board “to assure quality, cost effectiveness, and fair reimbursements for physician-delivered items and services.” The term “cost-effectiveness” is code for rationing, which the law acknowledges by prohibiting the use of assessment methods of determining “any value or cost-effectiveness that discriminate against people with disabilities.”
Private Payment for Covered Health Services Would Effectively Be Banned: The bill requires that all covered medical services be provided without any out-of-pocket cost to patients. The only fee to which a doctor, hospital, or other service provider would be entitled would be that paid by the government. Kiss the health-insurance industry goodbye.
Doctors and Hospitals Would Become Government Contractors: The state would not, strictly speaking, employ doctors directly. But doctors would be coerced into becoming government contractors by the requirement that they sign a “participation agreement” to be eligible to receive payments from the government. The participation agreement forces medical professionals and institutions to:
Doctors who object to the provisions of a participation agreement would have little choice if they wanted to continue their careers, since they could be compensated for services only if they were deemed “qualified providers,” a status restricted to those who sign the agreement. (This is known in law as a “contract of adhesion,” meaning providers have no bargaining power or ability to negotiate terms.) If an individual provider’s agreement were revoked, he or she would be ineligible to be hired by a hospital or medical group, because their participation agreements require that they not employ any provider whose participation plan was “terminated for cause.”
Private-Pay Health Care Would Be Destroyed: What about doctors who wish to operate concierge practices, that is, accept cash directly from patients? Outside of the few non-covered fields such as cosmetic surgery, good luck! The doctor cannot have signed a participation agreement, since qualified providers “may not bill or enter into any private contract with any individual eligible for benefits under the Act for any item or service that is a benefit under this Act.” That means the doctor’s entire practice would have to be made up of people who opted not to be covered by the government, a very small pool of patients — the few very wealthy who could afford to foot their entire medical expenses out of their own pockets, and I suppose, “medical tourists” who travel to the U.S. for the purpose of obtaining treatment.
The Bill Seeks to Remove Profit in the Health-Care Sector: True to its socialist roots, the would eliminate profit in health care. Indeed, the bill states quite explicitly:
It is the sense of Congress that tens of millions of people in the United States do not receive healthcare services while billions of dollars that could be spent on providing health care are diverted to profit. There is a moral imperative to correct the massive deficiencies in our current health system and to eliminate profit from the provision of health care.
To enforce the “sense of Congress,” the bill forbids bureaucrats who determine the medical fees that will be paid to providers — which includes institutions as well as doctors and group practices — from taking into account the costs of “marketing” the “profit or net revenue of the provider, or increasing the profit or net revenue of the provider” or “incentive payments, bonuses, or other compensation based on patient utilization of items and services, or any financial measure applied with respect to the provider.” You think doctors have trouble receiving adequate compensation from Medicare and Medicaid now? Just you wait!
The Government Could Steal Pharmaceutical Patents: The bill requires the government to negotiate the price of medicines with drug companies. The bargaining power in that negotiation would — as with participation agreements — be all with the government. If a company refused to agree to the government’s price, the bill states, “The Secretary shall authorize the use of any patent,” by another company “for purposes of manufacturing such drug for sale under Medicare for All Program,” with compensation paid to the patent-owning company in an amount determined by the bureaucracy. How willing would pharmaceutical executives be to green-light the billions in investments required to develop new medicines knowing that the government could simply seize their patent and license another company to manufacture the drugs if they refused to sell it at a price the government demands?
Illegal Aliens Would Receive Free Health Care. Eligibility to receive benefits is not limited to citizens and aliens here legally. Rather, the bill reads: “Every individual who is a resident of the United States is entitled to benefits for health care services under this Act.” Illegal aliens living here are residents. Talk about a migration magnet. The only limitation on coverage for aliens is a provision that forbids eligibility to anyone traveling here “for the sole purpose of obtaining health care items and services provided under the program.” That’s much less than meets the eye. If an illegal alien traveled here to work, to escape violence, or to be with family, the exclusion clause would not apply. Further demonstrating the intent to cover those here illegally, enrollment in the program would be automatic “at the time of birth in the United States (or upon establishment of residence in the United States).” Residency could conceivably be established by a state driver’s license — now widely allowed illegal aliens — or even a utility bill. And get this: Unlike today’s Medicare identifier, the new Medicare Card would specifically not include a Social Security number, which many illegal aliens don’t possess.
Women Would Receive Free Abortion: Currently, the “Hyde Amendment” prohibits federal funding of abortion. That rare bit of culture-wars comity would be destroyed by the bill, which provides: “Any other provision of law in effect on the date of enactment of this Act restricting the use of Federal funds [i.e., Hyde] for any reproductive health service shall not apply to monies in the Trust Fund [the government entity that would be established to pay health-care costs].”
The Medicare for All Act of 2019 won’t become law while there is a Republican Senate and president. But the 107 co-sponsors in the House have put the country on notice. If the Democrats take over the government in 2021 as they — and some Never Trump Republicans — hope, by 2022, the United States health-care system will become a wholly controlled subsidiary of the United States government, bereft of liberty, increasingly sclerotic, managed by unelected bureaucrats churning out thousands of pages of onerous regulations, a centralized authoritarian mess from which the country’s health-care system would never recover.
Health Reform: How do you enact a massive new program, and then keep it from being repealed after it fails? It’s simple. Just pull the numbers out of thin air. That’s basically what happened with ObamaCare.
When centrist Democrats were deciding whether to support ObamaCare in 2010, the “nonpartisan” Congressional Budget Office told them not to worry. The law, it said, would cut the deficit. It would bring 24 million people into the new ObamaCare exchanges. Subsidy costs would be modest. And the number of uninsured would fall by more than half. Those Dems signed on.
ObamaCare Repeal Thwarted
Seven years later, as centrist Republicans contemplated an ObamaCare repeal-and-replace plan, the CBO warned that doing so would boost the number of uninsured by 22 million. That scared enough Republicans away to kill the bill.
Turns out, all those forecasts were way off.
ObamaCare boosted the deficit in its first 10 years. Only 8 million, not 24 million, people enrolled in the ObamaCare exchanges. The average cost of ObamaCare subsidies is 11% higher, and the number uninsured 36% higher, than the CBO projected.
Had the CBO been better at predicting the future of health care under ObamaCare, it’s likely that Democrats would have scaled back their plans, while perhaps seeking Republican input.
Now we learn that the CBO wildly exaggerated the impact of the Republicans’ repeal effort when it said that 22 million would lose coverage as a result. Almost all that loss was from repealing the individual mandate.
Wildly Inflated Numbers
CBO said 7 million people would drop out of the individual insurance market. Another 4 million would lose employer coverage. And 4 million would cancel their Medicaid — even though it’s free. All in the first year.
At the time, we argued that the CBO had hugely inflated those numbers because it vastly overestimated the effectiveness of the individual mandate.
Ironically, Republicans ended up repealing the individual mandate tax penalty, but keeping the rest of ObamaCare. So what happened?
This week, the Center for Medicare and Medicaid Services released its latest annual report on national health spending. The intrepid Philip Klein at the Washington Examiner noticed that, buried in a footnote, was a stunning rebuke of those CBO forecasts.
The report says that the mandate repeal will result in only 1.5 million dropping out of the individual insurance market, and 1 million from employer plans. CMS says Medicaid enrollment will “be unaffected.”
In other words, the CBO was off by a factor of six.
These forecasting errors don’t even rise to the “good enough for government work” level. But they were good enough to get ObamaCare on the books, and then keep it there.
By Christopher Jacobs • The Federalist
Researchers have raised legitimate questions about whether a policy change included in Obamacare actually increased death levels nationwide.
Some may recall that two years ago, liberals engaged in no small amount of hyperbolic rhetoric insisting that repealing Obamacare would kill Americans. They viewed that fact as a virtual certainty, and spent more time arguing over precisely how many individuals would die under the law’s repeal.
Somehow, however, the media that breathlessly covered claims about how repealing Obamacare would kill Americans hasn’t exactly rushed to highlight claims that the law could have increased the death rate. Continue reading
By Christopher Jacobs • The Federalist
Now they tell us! A Gallup poll, conducted last month to coincide with the midterm elections and released on Tuesday, demonstrated what I had posited for much of the summer: Individuals care more about rising health insurance premiums than coverage of pre-existing condition protections.
Of course, liberal think tanks and the media had no interest in promoting this narrative, posing misleading and one-sided polling questions to conclude that individuals liked Obamacare’s pre-existing condition “protections,” without simultaneously asking whether people liked the cost of those provisions.
Overwhelming Concern about Premiums
The Gallup survey asked the public whether it viewed each of four scenarios as a major concern for them. Among those: “Your health insurance plan will require you to pay higher premiums or a greater portion of medical expenses,” and “you or someone in your immediate family will be denied health insurance coverage for a pre-existing medical condition.” Continue reading
By Charlie Katebi • The Federalist
Over the last several years, states that expanded Medicaid to able-bodied adults have seen costs skyrocket and patients lose access to critical medical care. Yet despite this disastrous track record, many are recklessly rushing to expand Medicaid in their states.
On July 6, Medicaid expansion advocates delivered boxes full of signatures to Idaho’s secretary of state to place the issue on the state’s ballot in November. Just one day earlier, another ballot drive collected enough signatures to expand Medicaid in Nebraska. In Maine, pro-Medicaid lawmakers are preparing to raise fresh new taxes to grow the program.
The leaders of these campaigns argue that expanding Medicaid will provide health care access to the needy. Unfortunately, expanding coverage to able-bodied adults imposes enormous harm on Medicaid’s traditional enrollees, which include individuals with severe Continue reading
Health Reform: Since 2014, Democrats have greeted double-digit hikes in ObamaCare premiums with a yawn. Now it’s a crisis that must be fixed immediately. What’s changed?
Huge increases in ObamaCare premiums are the norm. In its first year, ObamaCare forced costs in the individual insurance market up by double digits. Subsequent eye-popping jumps followed. The average premium climbed about 7% in 2015, 11% in 2016, 22% in 2017, and by more than 30% in 2018.
The Health and Human Services Department calculated that, overall, premiums more than doubled between 2013 — the year before ObamaCare went into effect — and 2017. Continue reading
By Nan Hayworth • The Hill
As a physician whose career in medicine was dedicated to preserving and improving my patients’ health, I know firsthand how important it is for everyone to have access to care. This is a fundamental precept, morally and pragmatically sound, that should be honored by all who seek to transform for the better America’s flawed system of health care delivery.
Regrettably, since its passage in 2010, the Affordable Care Act (ACA) has had the net general effect of raising the cost of health insurance while reducing the quality and variety of the services that insurance covers. This is the opposite of what was intended — but the suffering engendered thereby is real and painful.
The best-case remedy would be to repeal the ACA completely and replace it with a much simpler, more targeted set of common-sense interventions to empower consumers and ensure their access to Continue reading
By Sally C. Pipes • Investor’s Business Daily
ObamaCare enrollees should brace themselves for another year of double-digit premium hikes.
Average premiums for plans sold through the state and federal insurance exchanges will jump as much as 32% next year, according to a recent report from actuarial firm Milliman. Consumers in some markets could face 80% rate hikes, according to a separate analysis from Blue Cross Blue Shield.
Democrats have pounced on these projections to blame the GOP for “marketplace sabotage.” Senate Minority Leader Chuck Schumer, D-N.Y., remarked that “Republicans and the Trump administration own any and all increases in health care premiums for American consumers.”
Sorry Chuck, but GOP malfeasance isn’t the problem. ObamaCare’s burdensome Continue reading
By Charles Silver & David A. Hyman • National Review
If you’ve ever been in a collision, you’ve probably dealt with a body shop. In all likelihood, the process went smoothly. You paid your deductible, your insurer paid the rest, and that was the end of the financial side of the repair.
Health care works differently. After eight-year-old Ben Millheim injured himself during a camping trip, his family was stuck with a $32,000 bill from the sky-ambulance company that flew him 88 miles to a hospital in St. Louis. That was the balance that remained after the Millheims’ insurer paid $12,000 for the service. Elizabeth Moreno was stuck with a bill for $17,850 because a physician asked her to provide a urine sample. She didn’t know that the doctor’s testing lab was out of her insurance network. Moreno’s insurer, Blue Cross Blue Shield of Texas, which would have paid an in-network lab $101 for the service, refused to cover the bill at all. Fearing for his daughter’s credit rating, Moreno’s father bargained the bill down to $5,000 and paid.
The Millheims and Morenos are but two of the tens of thousands of families who receive surprise medical bills every year. These are “balance bills,” that seek to hold patients responsible for charges their insurers won’t pay. The problem is so bad and so Continue reading
Health Reform: For three years running, the uninsured rate has remained unchanged, new government data show. That means, despite massive taxpayer costs, ObamaCare is tapped out. It’s time to try something better.
According to the Centers for Disease Control, the overall uninsured rate last year was 9.1%, the same as it was in 2015.
If you take out retirees, who are automatically covered by Medicare, the uninsured rate was 10.7% last year, up a fraction from 10.5% in 2015.
The uninsured rate for the near poor Continue reading
Health Care: The ranks of the uninsured climbed last year. So, naturally, President Trump is taking the blame because of his attempts to repeal ObamaCare. The fault, however, lies not with Trump, but with ObamaCare itself.
A new Gallup report shows that the ranks of the uninsured climbed from 10.9% in Q4 2016 to 12.2% by Q4 2017. At first blush, it makes sense to point to Trump, given that this increase came during his first year in office.
As Huffington Post put it: “Trump’s sabotage of the Affordable Care Act appears to be working.”
But a closer look at the data and a review of recent history shows Continue reading
It’s beginning to look like the Republicans have pretty much abandoned their promise to “repeal and replace” Obamacare. Considering they don’t have the votes to do it this does not come as a big surprise. If they want to remain in power though, they have to come up with something.
Fortunately, President Donald Trump is leading and may announce as soon as Thursday a plan to bring the cost of prescription drugs down using market forces rather than mandates. Working through Health and Human Services Secretary Alex Azar, the administration is expected to strongly endorse price competition though the formulary process (developing a list of approved drugs selected to provide the most value) as the key to controlling drug costs.
This is what the voters want. According to several recent polls controlling drug costs is one of the three or four issues most important to people deemed likely to vote in the next elections. Therefore, it’s fortunate good policy and good politics are intersect this way.
Even common-sense approaches to controlling costs — like moving prescription drugs from Medicare Part B to Medicare Part D to increase the government’s ability to negotiate on price — will face fierce opposition on Capitol Hill from drug makers (PhRMA spent $150 million in advertising in favor of Obamacare passage) and from those who believe a Bernie Sanders-style single payer approach is the only reform Congress should even think about enacting.
It’s up to House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell whether they want to follow Mr. Trump’s lead and go further. They’ve been burned, badly, by their failure to “repeal and replace” and with their colleagues are reluctant to take up the issue again.
From a political standpoint, that would be an epic fail leading to serious consequences for the GOP’s congressional majority. Rather than wipe the slate clean, they can utilize now-proven concepts used by pharmacy benefits managers, or PBMs, to produce savings for consumers. Again, this is something the voters want.
No one has to go all in at first. Moving drugs to Medicare Part D as a demonstration project for certain therapeutic classes could be the first step toward future, system-wide reform if, as it is almost certain to do, it works.
On the formulary side, the idea of allowing approved plans to cover just one drug per category or class within Medicare’s protected classes rather than two would also increase the government’s bargaining power on behalf of patients. That could be a tough sell in a town where drug companies spend millions on lobbyists to make sure that profits stay high, but as part of a package of reforms coming out of HHS to lower drug prices and reduce out-of-pocket costs it would just be one of many changes producing cheaper health care without compromising quality or access.
The changes the administration is expected to make can be enacted quickly and efficiently. Costs will come down in the near term in a way meaningful to most consumers. In the long run there’s still much to be done.
Obamacare did not deliver on its promise: People lost the health care they liked, what they could get was more expensive, year by year, and the range of choices available to them contracted. The only way to fix that permanently, as health care experts Grace-Marie Arnett and Marie Fishpaw explained recently, is for Congress to take up a plan addressing three big goals: 1) lower costs and improve patient choices, 2) give states flexibility and resources to achieve these goals, and 3) set federal guardrails so people can choose private coverage if they don’t like the options their state provides.
As Ms. Arnett and Ms. Fishpaw put it, America needs health care reform that recognizes “what works in Massachusetts will not work in Mississippi or Missouri or Montana. What works in big cities will not work in rural areas. In response, we would provide states with greater flexibility and new resources to serve as stewards in returning freedom and choice over health decisions to patients.”
To get to that point, the GOP needs a bigger majority in the U.S. Senate and to hang on in the U.S. House of Representatives. Right now, the Republicans look to be losing seats in the House and probably the majority. That would be the end of real reform. A Democratic majority will define reform as an increase in the role for government and a taxpayer-funded bailout of insurance plans.
What Mr. Trump is supposedly getting ready to propose may not just save health care but may also save the Republican majority, which cannot get through the election without addressing the issue. Finding and supporting ways to cut the cost of prescription drugs may be, in the short run, the only option left.