Today’s Managing Health Care Costs Number
is 5
I’m back from a week off – and the bike ride and the beach were great. Now, back to wonkiness and health care.
I listened to snippets of the Republican health care debate on Thursday night –and there wasn’t much about health care. The Washington Post posted a transcript –and I looked for words associated with health care. I found only five words or phrases:
· Health Care (2 mentions)
· Abortion (10 mentions)
· Obamacare (11 mentions)
· Planned Parenthood (15 mentions)
I reviewed the transcript for the ‘undercard” debate, too. Mentions of abortion (14) and Planned Parenthood (14) overwhelmed “health care “ (7) and “ObamaCare” (7) in that debate as well.
I was emailing with one of my conservative friends the other day –and he expressed a sense of frustration that the serious health care policies that have been put forward by economists and policymakers on the right are being totally ignored.
This is especially ironic, since the heart of ObamaCare was designed during the Nixon Administration as a private market alternative to national health insurance. Further, the move to high deductible health plans and health care savings accounts has been championed by conservatives – and the health care financing system has made big leaps in that direction over the last few years.
I looked back to the op-ed in the New England Journal“Bending the Cost Curve Through Market Based Incentives” written by right-leaning health care policy experts prior to the 2012 election. (It’s available with no paywall). Recommendations included:
· Shift Medicare from a defined benefit to a defined contribution plan – essentially fixing subsidies at current levels. If health care costs rise more, patients will pay the difference. Slyly, this is dubbed “premium support.”
· Convert the current tax exclusion of employer sponsored health plans to a fixed refundable tax credit, or at least cap the tax exclusion. (That’s effectively what the “Cadillac” excise tax in the Affordable Care Act does, although a cap on the tax exclusion would be ‘cleaner.’)
· Combine Medicare Part A and Part B deductibles. (This is something that would make Medicare much more like employer-sponsored insurance, and remove a gnarly hard-to-understand distinction for patients who are often caught off guard when outpatient services are substituted for inpatient admissions.)
· Split CMS into regional health plans for ‘traditional Medicare.” Each would have their own administration, which the authors feel would be more accountable. Overhead would go up.
· Do away with state regulations that increase the cost of health insurance through coverage mandates and which increase complexity for employers, who often have beneficiaries in many states. Note that most Americans with employer sponsored insurance are in “self insured” plans which are already exempt from these state regulations.
· Allow sale of bare bones health plans for those who want to purchase less coverage. This would include the “minimed” plans with maximums of $1000 to $5000 which were banned by the Affordable Care Act.
· Allow sale of fully-insured health insurance plans across state lines. This would effectively do away with many of the state mandates and regulations, as insurers would seek to domicile in the states with the most lax regulation, much as credit card companies are so often based in South Dakota, and corporations choose to incorporate in Delaware.
You can tell that I’m not a fan of the conservative agenda for health care. I feel that patients are vulnerable when they are sick, and aren’t in a good position to negotiate. I know that’s especially true of the 5% of people who are highest cost, who alone represent about half of all expenditures. I am comfortable to let health insurance to serve as a transfer of wealth from those lucky enough to enjoy good health to those unlucky enough to be gravely ill. I like the fact that some states like Massachusetts can choose to more vigorously regulate fully insured health insurers. I watched Michael Moore’s documentary Sicko in 2007 and was relieved that most of the worst insurer practices had been banned in my state for years.
But there are some real ideas on the right – more than the trope of “repeal and replace” or “job killing ObamaCare” or “let’s defund Planned Parenthood.” It’s certainly hard to get beyond sound bites with so many candidates clogging the stage, but I hope we’ll hear a little more about what the candidates really want to do with health care in the coming months.
