At Business Insider Josh Barro presents a list of proposed reforms to the health care system, by implication associating them with Elizabeth Warren. Here they are in bullet point form:
- Impose price controls on prescription drugs.
- Block hospital-system mergers, so healthcare providers have less power to raise prices.
- Offer a Medicaid-based public option, so people can buy insurance that enjoys Medicaid’s low negotiated payment rates — and that can therefore offer more affordable premiums and deductibles.
- Break up state medical cartels. Force states to allow nurse practitioners an appropriately broad scope of practice, to recognize other states’ medical board certifications, and to honor foreign medical degrees. Abolish “certificate of need” requirements that make it hard to open new medical facilities. Issue more visas to foreign doctors and nurses. These changes would make it easier to find a medical provider and put downward pressure on prices.
- Ban surprise medical bills. A hospital that’s in your network shouldn’t be able to stick you with an astronomical bill for an out-of-network anesthesiologist you didn’t even know was going to treat you.
- Move more drugs and medical devices over-the-counter. Warren and Sen. Chuck Grassley, a Republican, have a bipartisan bill to allow some hearing aids to be sold without a prescription. Some forms of hormonal birth control could also be made available OTC.
I won’t analyze those point by point. My criticism resembles something I said earlier today: even if fully implemented that list of reforms would do almost nothing to slowing the increase in health care costs.
“Medicaid for All” will not have the effects Mr. Barro implies. At least not as long as Medicare exists and its reimbursement rate is higher than Medicaid’s. To claim otherwise is to claim that doctors and hospitals will leave money on the table. That’s a strong claim requiring serious evidence rather than just blithe reassurances. You might extend coverage that way but not care. About 70% of physicians presently accept new Medicaid patients. Expect that to drop under “Medicaid for All”.
If you remove the artificial restrictions, a Medicaid-for-Anybody policy would work. There is no amount of money too small to find somebody willing to provide a good or service to obtain it.
A cap on prescription drugs is not needed. If the Medicaid-for-Anybody policy included generic drugs, the increased demand would be met no matter how slim the profit margin.
The barriers to a well-regulated market would need to be removed, but this would require people a little smarter than their IQ indicate they are.
Could somebody with one of those ginormous IQ’s explain why I need to submit a prescription to buy glasses? What other consumer product requires a government approved specialist inform me of what I can buy.
Tax employer provided health insurance as income, and see how fast the Medicaid-for-Anybody becomes the most popular option.
An idea that’s been wondering in my head for a bit.
Here’s something that connects two different priorities (student debt and health care costs). The government offers students a reduction in education debt in return for a lifelong contract to accept Medicaid patients (and if they break it, a 90% tax on “surplus income”). While we are at it, force all medical schools to accept students directly from high school and get rid of summer breaks.
I have to wonder if there’s a link between physician salaries and the fact they spend ~10 years in post-secondary education not earning money. Time = money and add in the law of compounding and student debt and they have a lot of pressure to earn as much as possible.
Maybe if they have more earning years and less debt to start with doctors would be more willing to earn a lower yearly pay.
No, there’s no relation. That’s a rationalization.
If there were a relation, PhDs in art history would be bringing in the big bucks. They’ve gone to school for just as long as docs.
Salaries are based on what the market will bear not on inputs. The cost of the inputs including opportunity costs tells you whether it’s a good investment not what its value is.
1) Medicaid covers a very restricted population, so many specialists will never need to see a Medicaid patient.
2) Pretty sure almost all non-profits see Medicaid pts.
3) When surveyed, Medicaid patients don’t have much more trouble finding care than patients with Medicare and private insurance.
4) Medicaid payments vary a lot. For the patients that Medicaid actually covers, like OB patients, it can pay surprisingly well.
5) If the prices can’t come down, someone recently wrote a blog post claiming prices need to come down, then it is true Medicaid likely fails. However, if prices can come down, then Medicaid is probably as good as most other insurance.
6) You could certainly cap the prices on the generics that have been around for 50 years then increase by 1000%. You could do that w/o affecting innovation.
7) Not sure why we have to bear the costs for all drug innovation. We could set prices at 120% of whatever the OECD average is, or something like that. Reimportation anyone?
8) There is a bit of a relation. Med school and residency is a lot more hours than art school, and costs more. Primary care docs spend less time in training, and it is often easier. Specialists usually spend more time in training, and the hours are worse. (Not always, but a general rule.)
9) CONs can go. Let mid-levels do more, but with a plan and not just for all of them. We can try for more foreign grads. Other countries seem to top out at around 25% foreign grads. We might be able to top that, or it could be that there just isn’t enough cohesion if no one speaks the same language. We should ban the surprise bills out of simple ethical considerations, but it won’t really save a lot of money.
Steve
Well, I just thinking medical practitioners will accept pay cuts more willingly if they got something in return. A lower debt burden at the beginning of their careers seemed a pretty attractive trade off.
I am a little bit weary about excessive dependence on foreign doctors — is it really moral to export the US problems with the number of doctors/nurses to other countries — many of them don’t have enough doctors/nurses as it is. Has anyone explored sending patients to Canada for treatment (which seems more moral)?
Regarding drugs — We already have the powers to pressure the prices of most drugs, like strictly enforcing patent terms or antitrust violations for generics, but we don’t use them.