10 Bipartisan Ideas for Affordable, Quality Health Care
The Senate’s failed vote on the Health Care Freedom Act, otherwise known as the “skinny bill,” confirms that quick fixes and hasty repeal measures without a solid plan in place for health care kicks the problem down the road and creates uncertainty for millions of Americans. This latest round of votes treated the symptoms but not the malady of excessive health care costs.
It’s time for a new approach to fixing our broken health care system. A responsible Congress could consider this moment as a unique opportunity to address health care costs, take advantage of amazing new technologies and improve the overall health and wellness of Americans.
Here are ten proposals that Republicans and Democrats should consider and approach with bipartisanship, ensuring both government and Americans pay less and get better health care:
1. Cut drug costs.
Americans pay more than double what citizens of other countries pay for many prescription drugs. Billions of dollars in government spending on health care can be freed up if the government is able to negotiate drug prices. The pharmaceutical industry needs to be able to fund future research and development -- but there are other ways to do this rather than raising drug prices.
The U.S. government should be able to negotiate drug prices and Americans should be able to buy prescription drugs in Canada, an idea supported by both Sens. Bernie Sanders (I-Vt.) and Ted Cruz (R-Texas). We can also encourage Americans to use generics drugs when the government is paying -- a position supported by the Problem Solvers Caucus, a bipartisan coalition of Democrats and Republicans. And we can stop incentivizing doctors to use the most expensive drugs by making rebates illegal and blocking reimbursements based on a percentage of drug costs. Everyone -- doctors and drug companies alike -- has to start paying attention to costs.
2. Allow veterans to use convenient hospitals.
VA hospitals face challenges in delivering timely and effective treatment. Let’s allow any American hospital to treat our veterans. Let’s create a new system where veterans receive vouchers -- in time, effective VA hospitals will thrive, while others will shrink or be eliminated due to lack of veteran customers. We owe it to our veterans to deliver convenient, timely and effective treatment.
3. Trim Medicare costs by slowly raising the age and income eligibility.
The Medicare eligibility age has held steady since Medicare was created in 1965, yet our average life expectancy has increased from 70.2 years that year to 79.4 years in 2015. Moreover, every American is eligible for Medicare at age 65, no matter how wealthy they are or if they have employer-sponsored health care. The cost of Medicare is increasing, we are living longer and most wealthy people do not need a Medicare subsidy.
4. Allow insurance to be purchased across state lines.
This was President Trump’s campaign pledge -- it makes sense and will promote competition. States need clear guidelines and the flexibility to innovate to make exchanges work for their residents. Guidelines will also allow states to bring more choices to consumers while increasing competition, another idea supported by the Problem Solvers Caucus.
The jobs of state insurance commissioners should not be more important than the needs of the American people, especially when it comes to the need for a robust and competitive insurance market.
5. Limit doctor malpractice risks.
Doctors are in short supply in certain specialties, in part because medical malpractice insurance is too high and too many lawyers thrive on tragedy. Highly-trained doctors shouldn’t stop practicing because they can’t afford malpractice insurance premiums. Statutory caps on lawsuits, liability thresholds for claims and even fixed payments for certain physical outcomes would help reduce doctor costs.
6. Encourage use of technology to cut costs and achieve better outcomes.
Technology can now be used to promote wellness and cut down on costly doctor visits. For example, smartphones allow patients to provide their health care providers with information necessary to diagnose illness and even prescribe treatment. At the Consumer Technology Association (CTA), our employees can quickly consult doctors -- including specialists -- by telephone. This capability has allowed our employees to avoid several unnecessary emergency room or urgent care visits.
Yet when the government is involved, doctors cannot be paid for a telephone consultation. With the internet of things and sensors embedded in technology, health care providers can remotely monitor patients to determine whether a doctor’s visit is necessary. But liability and insurance laws do not encourage this as a treatment adjunct. The promise of Obamacare was in the sharing of treatment information, but even the American Medical Association and the Obama administration have said that the transfer of information via electronic medical records has failed because of a lack of standards and high doctor costs for the necessary software.
Entrepreneurs are stepping up to use data to drive treatments. Arterys -- a cloud-based computing platform for medical imaging -- gathers data from hospital equipment globally, processes anonymized patient data and analyzes it against the treatment and results. The Focused Ultrasound Foundation increasingly provides alternative treatments to chemotherapy or radiation. Digital therapeutics -- a method using a digital system as a stand-alone or in combination with conventional therapies to treat a medical condition -- hold the promise to change behavior, one of the most important challenges in health care, due in part to their relatively low cost.
Medical treatment will be more effective and focused in ten years than it is today, but the medical device tax of 2.3 percent is restrictive. This added cost is passed directly on to consumers and should be repealed. Government should support health care advances by embracing breakthroughs in technology -- not by taxing innovation.
7. Consider the costs of patient and caretaker needs as factors in treatments, drug approvals, and reimbursements.
Our incentive structure for treating patients is off. For example, in some cases, Medicare and Medicaid pay doctors for each separate appointment if they do not diagnose and treat in the same visit, encouraging doctors to require two visits when one visit would suffice. This places huge burdens on patients who require a caregiver or special transportation to get them to the doctor.
Also, the Food and Drug Administration does not consider how often a drug must be administered by a doctor before approving it. My wife, a retina specialist, developed an effective treatment for macular edema which can be administered every eight months; compare the savings and time saved by this to a much higher-priced treatment that must be administered by a doctor every month. Doctors everywhere are eager to learn about the treatment, but there is little incentive in the U.S. to provide it. The current focus on profits -- over quality care -- needs to shift.
8. Encourage people to think through end-of-life decisions in advance.
Medicare recipients incur one-quarter of all medical costs within the last year of life. Patients should be given the opportunity when healthy to indicate their wishes to their family about whether to pursue treatment at all costs. By asking -- but not requiring -- Americans to indicate their end-of-life preferences when they register to vote or get their driver’s licenses, we can mitigate heartache and indecision later.
9. Self-driving technology development must be encouraged.
More than 35,000 Americans are killed annually on our roads and many more are seriously injured. Self-driving cars should cut these deaths by half over the next several years. Self-driving technology will reduce the number of traffic crashes and save countless lives, solving one of the greatest public health challenges of our lifetime.
10. Encourage personal ownership of health insurance.
Obamacare requires the government to pay to insure millions of individuals not covered by corporate health insurance. While Congress has failed to provide a plan that encourages individuals to purchase their own health insurance efficiently and pass the muster of a solid Congressional Budget Office score, it is worth pursuing. It also would take away the corporate burden and American business disadvantage of requiring internal corporate staff and expertise on health insurance. Any health plan that gains the consensus of multiple think tanks, trade associations and the CBO, by proving to insure more than Obamacare, will gain bipartisan support.
We have the most bulky and costly health care system in the world. We have an opportunity to change that through smart policy by transforming Obamacare into a system which serves millions of Americans without adding to the deficit.
Americans are ready for a bipartisan solution -- 86 percent of voters want Democrats and Republicans to work together on an Obamacare replacement, according to the latest Harvard-Harris poll. It’s time to move past the political rhetoric, focus on real solutions and agree on bipartisan compromises. Simply cutting off Americans from insurance and forcing them into emergency rooms is not the answer: We need health care policies that promote innovation and keep costs low. That is the model for the 21st-century economy.
Gary Shapiro is president and CEO of the Consumer Technology Association (CTA)™, the U.S. trade association representing more than 2,200 consumer technology companies, and author of the New York Times best-selling books, Ninja Innovation: The Ten Killer Strategies of the World's Most Successful Businesses and The Comeback: How Innovation Will Restore the American Dream. His views are his own. Connect with him on Twitter: @GaryShapiro.