What policy changes are being proposed by the experts to lower the costs of health care in the US, besides UHC?
Thanks,
Rob
I don’t know about any experts, but one puzzle piece I often hear bandied about - and that makes some sense to me - is making it so that consumers have some skin in the game, and are able to intelligently negotiate. A HUGE amount of testing/care is of negligible utility, but there is little incentive for a medicare recipient (just one example) to question any recommendation if costs appear to be borne primarily by "someone else - whether the government, an insurer, or eaten by the provider.
Of course, I was not persuaded that W’s “savings accounts” were a good idea either… And consumers are in a hugely disadvantaged position both in terms of information, and the stress of needing care.
Another approach I’ve heard more off lately is trying to incentivize “wellness” - rewarding providers for getting ill people to decrease the care received, as opposed to simply compensating for procedures performed.
Finally, hospice and palliative care, and end of life planning seem to be increasing, which will hopefully reduce some of the egregious end-of-life treatment costs.
Which is the flaw in the argument: there is inequality of information between the consumer and the provider. “Intelligent negotiation” with a doctor would be difficult at the best of times, but when you’re sick and in pain it’s even more difficult.
A short while ago, I proposed one: make birth control and numerous other medications available over-the-counter, rather than by prescription only. Earlier this year, Senate Republicans offered a bill to make birth control available over the counter. Democrats shot it down, though they did offer a proposal of their own. But that’s a minor thing. As far as serious movement in Congress on reducing health care costs, I’m not aware of any.
In terms of ideas that our politicians aren’t bothering with, there are plenty. Eliminate regulations that prevent hospitals from expanding and new hospitals from being built, for starters.
By “experts”, do you mean those that know what the hell they are talking about but aren’t in a position of power to actually give us an actual choice, or do you mean those in a position of power that can give us whatever politics will allow at this time?
There is the whole prescription thing: you have to have a prescription to buy most drugs. Lots of countries make lots of these drugs available without a prescription. And in lots of countries the pharmacist or a nurse can make the decision. This is a cheaper approach.
Importation of drugs from foreign countries. If a drug has been legally approved in an advanced country it should be safe enough for the U.S., and is often much cheaper from foreign sources.
In the wake of the Daraprim price gouging scandal, Clinton promised to attempt reforms that might help in this area. She has proposed idea such as a $250 out of pocket price cap that would apply to insurances, as well as just general government negotiations, even without actual UHC. She also is pushing the FDA to actively encourage competition by expediting applications for generics that currently have only one seller.
You can read more about her plan here.
I think birth control over the counter isn’t feasible. How many of us have the ability to know how to prescribe the correct drug and know how it interacts with other drugs the patient may be taken, what is appropriate for the age of the patient and her medical history, and so on. Funny how Republicans were willing to let women prescribe their own meds but they want them to suffer through an ultrasound and a waiting period and a long drive to a clinic subject to vindictive requirements should their self-medication not work.
Single-payer would indeed reduce many costs, but beyond single-payer:
Bundled, or episodic payment systems with quality or wellness measures.
Increased use of managed care, with ties to wellness or other quality measures.
Social determinant screening.
Person-centered health homes for heavy users.
Increased end-of-life conversations and doctor payment.
Rebalancing from institutional care to community or home care.
Control of unnecessary hospital readmissions.
Increased health information sharing.
Care coordination.
Telemedicine.
Other issues surrounding Medicaid payment, physician incentives and training, increased use of paramedical or community health workers, increased use of nurse practitioners, RNs, PAs, and pharmacists.
The GOP has been pushing tort reform as an idea to actually reduce, as opposed to slow the increase of, health care costs. Given the amount of campaign money that tort lawyers donate to Democrats, I doubt if the Dems are going to go along with it.
Regards,
Shodan
Tom Price, who is a Dr and also the chairman of the House Budget Committee, came and spoke to my company last year (he’s my congressman, and my CEO donates to his campaign). He straight up admitted that even the most aggressive tort reform is not going to change prices by more than 1-2%. CBO agrees with that, btw.
Tort reform is not a serious attempt to lower prices for anyone but a doctor’s insurance premium.
As I said, when it comes to GOP proposals to reduce costs, the Dems suddenly lose interest in reducing costs.
Regards,
Shodan
From what I understand, countries such as France and Germany make birth control available without the prescription barrier. I’ve spent time in both countries and don’t recall seeing women dropping in the streets from incorrectly used birth control.
If you’re willing to “reduce” costs by denying injured people the right to sue the person who negligently injured them, you’re not really reducing the costs. You’re just shifting them to the public to take care of.
Anyway, I think you’ve got it backwards. The Republicans want tort reform in large part to de-fund trial lawyers (and their support for the Democratic Party), not reduce health care costs. See, for examplethis article from the American Spectator:
Defunding the
Democratic Party
Good policy is good politics. And vice versa.
.
The New England Journal of Medicine published a study about tort reform:
Here’s an articlethat mentions it, I’m sure someone can find the actual study on line:
This is an “out there” proposal but I have worked in both the health insurance and Big Pharma as a consultant for much of my career. The entire billing process is a complete mess. There is no way to talk with your doctor about costs because they don’t usually know what any particular procedure, even the simplest ones, will cost you, 3rd parties or anyone else. Even patients covered by traditional private insurance are all different because each of those is customized by their employer and often changes completely from year to year.
I see the lack of transparency in price information to be the biggest hurdle to overcome. I am not sure exactly how it would work but one big step would be to force hospitals and doctors to provide detailed price information to patients upfront on request. The idea would be similar to a restaurant menu except it doesn’t need to be that low tech. A website or smartphone app could probably give better information. “Rack rates” (people that want to pay for services themselves for whatever reason) would also need to be equivalent to insurance company costs for the same procedure. That doesn’t require true price controls. It would just mean that it would be illegal to charge people vastly different rates depending on the method of payment. That would cause hospitals and doctors to calculate costs more honestly instead of inflating them to absurd levels just to have a number.
One of the biggest problems is that there is no way for market forces to work in such an artificially constrained environment. If you told people upfront what different providers are going to charge for services, they will likely pick among the least expensive for simple services that any of them can do and may or may not make the decision to pay more when the stakes are higher such as life-threatening cancer.
Once people actually have a way to make an educated choice, prices for many services will come down naturally through competitive pressure.
I listened to this a few days ago.
If you don’t want to click, it’s an experiment going on in Maryland where hospitals are paid a single lump sum each year (edit - it’s called global budgeting). As for how it’s doing,
My doctor (with a second part time doctor and a couple of nurses) has 3 administrators to deal with billing and other such garbage. And you know there are a similar number of people on the insurance side reading all the bills they send. It’s crazy, the amount of time that goes into this stuff just to figure out who is going to pay and how much.
When you have as many administrative personnel as service personnel, calling the system ‘efficient’ is ridiculous. Unfortunately, you need an overarching construct to manage prices and billings to cut down on this cost.
Which is how the UK NHS has worked for 67 years…
I agree, with some caveats.
Some states like Colorado have tried this technique, but it isn’t very easy.
The only field of medicine where this has worked so far, as far as I can tell, is pharmaceuticals. There are many websites where you put in the drug you want and the dosage, and they tell you the price per pill. Prices can vary wildly, and obviously people will be drawn to the lowest price. I"ve found price differences of 400%+ between domestic pharmacies, international pharmacies have even bigger differences.
Pharma makes up something like 10% of medical spending in the US, but with the other 90% I don’t know if things have been as easy.
On top of public consumer prices you need other market forces. For one you need the state to negotiate prices with providers to lower prices.
You also need the state to determine which procedures are worth the expense. Not all procedures are worth it, and you need medical experts to determine which are worth paying for and which are not. That isn’t something the average person on the street can determine for themselves.
Most systems in the developed world place little or no responsibility on the consumer to compare prices. All the responsibility is taken up by the state to negotiate and determine which procedures are worth paying for vs not paying for and those systems work fine.
One thing that seems to be working somewhat is paying patients to seek out lower prices for their healthcare. One company that does this is called smart shopper. The gist of how this work is that if they see there are much cheaper options for a service you require, they will pay you a portion of the difference to go to the cheaper place. So if you need blood work done and one place charges $200 and another charges $50, they would pay you $25 to get it done at the cheaper place. There are some unintended consequences, but the process of making costs more transparent and making patients have a vested interest in seeking out that information will probably be good in the long run. Here is a podcast about the company if anyone is interested.