Responsible Change in Healthcare
Part 2- A roadmap to improved healthcare coverage
Part 1 of this discussion laid out the argument that many citizens of Tennessee’s First District are harmed by a lack of healthcare coverage. Before I discuss a plan, let’s make sure the goal is understood. First, what we want to achieve long term is universal coverage. In the future, we want every citizen to have access to healthcare. This is not the same as single payer. A single payer system could exist that didn’t cover everyone, and everyone could be covered with systems that are not single payer. For example, is Medicare a single payer? Given the supplemental insurance and co-pays that are a part of the program, I would say, “Not exactly.”
If we are going to expand healthcare coverage, then we need to find the money to do so. Any major revision to healthcare payment must be financially responsible. The U.S. government already spends over a trillion dollars a year on healthcare, and we need to stop passing on debt to future generations.
I believe that significant funds can be redirected with major changes in prescription drug cost management. Many drugs are far more costly in the U.S. than they are in other first-world countries. For example, the drug Nexium, commonly used for acid reflux, is more than nine times as expensive in the U.S. than it is in the Netherlands. There is no good reason why a U.S. patient needs to expend so much more money than a Dutch patient. Drug companies claim that the increased costs are for research and development, but such development benefits patients in other countries as well; there is no good reason for U.S. patients to bear all the cost.
Although one way to control medication costs is to mandate them legislatively, I would personally prefer the use of market forces when possible. I would therefore advocate changing the laws and Food and Drug Administration regulations so that U.S. pharmacies can buy medications from international suppliers when safety standards are maintained. Given that many drugs are made in the same facility, then shipped to U.S. or international locations based on medication orders, safety standards in many cases will be easy to maintain. The money saved can be used to treat more patients and cut patient co-pays.
Medical corruption is an area where the waste of taxpayer dollars is dramatic. Some experts believe that 10 percent of healthcare expenses are squandered on medical corruption. At present, law enforcement officers give low priority to these not-very-exciting cases. Also, multi-billion dollar corporations can hire large legal teams that vastly outspend prosecutors. However, medical corruption can be addressed with high expectations of success. A cadre of medical corruption experts within the U.S. Department of Justice would improve prosecution. Some of the revenue (perhaps 20 percent) from increased fines levied by this group of experts would fund the enhanced enforcement of existing laws. The remainder would be used to improve healthcare access.
“Medicare for All” has recently become a rallying cry for some healthcare advocates.
I personally advocate a more incremental expansion of Medicare. Incremental change implies that each step is monitored so that the whole plan has maximal chance of success. Results from each step would be studied and methods tweaked before the next expansion.
The first group to receive expansion would be Congress. Use of Medicare for their own healthcare needs would be an outstanding way for legislators to see firsthand the strengths and weaknesses of Medicare.
The second group for expansion would be people aged 62 and above. These folks are already eligible for Social Security, a key element of Medicare as it currently exists. Many people in this age group are working only for the healthcare benefits that come with their employment. If they were able to get Medicare earlier, they could retire and find other ways to contribute to their communities, and their jobs would become available for others who need them.
Under this roadmap, many Americans will not immediately benefit, but they will be phased in over time. With the Affordable Care Act still in place, everyone will have access to insurance coverage as the plan proceeds. My plan’s transition period allows the health insurance industry to continue to provide jobs to thousands of Americans, and it allows Americans the choice of the same supplemental insurance options they presently have.
Most importantly, the plan is fiscally responsible, since it will be paid for with money already in the system, repurposed for more efficiency. While I am sure the situation will evolve between now and January 2019, I plan to advocate for the key elements of this plan when I get to Congress.