How to slow the growth of health care costs.

Thanks to Susan Voss for her thoughtful essay about the complexities of our health care system, and how difficult it is to reduce costs. (See link to Register essay below.)   I don’t claim to have “the answer”, but I do suggest that the following cost saving ideas be given serious consideration.

  • Medicare, Medicaid and private insurance should not be required to cover every new drug, product, or procedure that is approved by the FDA. Some are very high cost but provide only marginal improvement over alternatives that cost much less.  Also, at least some covered products and procedures would likely be considered not medically necessary by most people.
  • Consider shortening the amount of time that government grants a monopoly for patents.  Patents are not natural property: humans have copied one another since the beginning of time.  Our U.S. Constitution allows patents to be granted to encourage inventiveness, but there is no objective reason why a patent must be granted for 20 years. Why won’t five or ten years work?  Maybe the length of the patent should be based on the cost to develop the patented item and whether or not government funds were used to help develop the item.
  • Don’t require limits on out-of-pocket payments such as co-payments, especially for very high cost items.  A person should have “skin-in-the-game” if they expect their insurance to cover very high cost items.  Today, we see the opposite: drug companies offer to help pay people’s out-of-pocket costs so there won’t be so much political pressure on them to lower their prices.
  • Allow both pharmacies and individuals to purchase drugs from sellers in other countries that are “deemed” to have sufficient safety procedures in place.  If drug companies are free to charge lower prices in other countries, then pharmacies and individuals should be free to purchase the drugs from those other countries.
  • Allow Medicare and Medicaid to negotiate with drug companies on prices they pay for the drugs that are covered by the programs.  Right along with that, Medicare and Medicaid should be allowed to develop formularies (lists of drugs that are preferred over other therapeutically similar drugs), that give beneficiaries a financial incentive to use the preferred drugs and a penalty for using higher cost drugs.

Our health care wants are unlimited.  Our ability to pay is not.  We, as citizens, should not expect private insurance or our government health care programs to cover everything, regardless of cost.  We should expect our government to NOT do things that increase costs, or reduce our choices.

Link to Register essay:  https://www.desmoinesregister.com/story/opinion/columnists/iowa-view/2018/09/19/dont-fooled-when-someone-claims-have-answer-soaring-health-care-costs/1355890002/

 

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Is our government responsible for the opioid crisis?

The Des Moines Register recently reported that 36 Iowa counties have joined in a law suit against opioid makers.  (See link to Register article below.)  Two law firms are enlisting counties across the country to go after drug manufacturers and others for the costs of the opioid crisis.  There is no cost to the counties.  If successful, the “Lawyers will  be awarded a portion of the settlement, …”  (Interesting that the word “settlement” is used instead of “judgment”.)

What is often missing in much of the opioid crisis discussion is how our government’s policy of prohibition has made a bad situation even worse.  When a person becomes physically addicted to opioids, they will do almost anything to get the drugs they want.  If the drugs are not available legally, or if legal drugs cost too much, addicts will find illegal alternatives. According to the CDC, 60% of opioid deaths do not involve prescription opioids.  That is, in 60% of opioid deaths the person who died was using illegal opioids.  (See CDC reference below.)  A significant problem with illegal drugs is that is no way to assure the quality and potency of the drugs.  In the case of opioids, that leads to inadvertent over-doses because the illegal drug was much more powerful than thought.

If opioid addicts were able to readily get prescription methadone or other FDA approved opioids at reasonable costs, many deaths would be prevented.  That would also take the profit out of the illegal opioid drug trade.  If opioid addicts were treated under a medical model rather than a criminal model, it is likely that more opioid addicts would seek help to solve their addiction problem.  But as it is, under our drug war, prohibition policy, addicts have good reason to not seek help.

CDC reference: https://www.cdc.gov/drugoverdose/data/overdose.html

Link to Register article: https://www.desmoinesregister.com/story/news/crime-and-courts/2018/01/05/iowa-counties-file-lawsuits-against-opioid-manufacturers/1008522001/

Transgendered okay in the military, but sex change surgery should not be paid for by taxpayers.

A transgendered person should be eligible to serve in the military, just like just like every other man or women, and just like every other gay or straight person.  If they are qualified to do the job, then government should not discriminate against them based on their transgendered status.  That does not mean the military or taxpayers should foot the bill for sex change operations.  Just as being transgendered is not a disease, surgery to to change a person’s sex is not a medical necessity.  Transgendered folks will can be completely healthy without a sex change operation.  So, sex change operations should be considered elective, and not be required to be covered by any insurance plan, including that of the military.

West Des Moines wrong on smoking and vaping ban.

It is a proper role of government to regulate activities on public property. But, it is unfair that West Des Moines has banned both smoking and vaping in their public parks.  There may be no safe level of second hand smoke or nicotine vaper, but there is also no safe level of car exhaust, or camp fire or barbecue grill fumes, but we don’t ban them.  Life is not risk free.  And really, isn’t it pretty easy for anyone who happens to be down wind from a smoker or vaper to avoid the situation by simply moving a little bit?  Smokers and vapers pay taxes that fund public parks just like everyone else.  This is simply a case of an intolerant majority oppressing an out-of-favor minority.  I hope that other municipalities will not follow suit.  p.s. – I don’t smoke or vape.

University of Iowa – wrong on tobacco policy.

The Des Moines Register recently reported that the University of Iowa (UI) has decided to implement a policy next Fall to prohibit all forms of tobacco anywhere on its campus.  (See link below to Register article.)  UI already has a policy that prohibits all smoking on campus.  The new policy would extend the ban to all forms of nicotine, including vapor and chewing tobacco.  The new policy will apply to students, faculty, staff and visitors.  It covers all university buildings and vehicles, plus all outdoor areas controlled by UI. UI is a government institution, and it is proper for governments to prohibit smoking inside or near entrances to government owned buildings because of the risks associated with second hand smoke.  For the same reason, it also seems proper to prohibit nicotine vapor inside government buildings.  But, smoking outside should not be prohibited.  Our air is not and has never been perfectly pure.  I would guess that automobiles, forest fires, power plants and volcanoes each put much more harmful pollution into our outdoor air than tobacco smokers.  Even worse, prohibiting smokeless (chewing) tobacco is just mean spirited.  It is not the proper role for government to prohibit us from legal activities that clearly harm no one other than ourselves.  Living involves risks.  As a person who does not use tobacco in any form, I have decided to not take those risks. But people who do no harm to others should be free to decide what risks they take with their lives, and neither I, nor any majority, should be able to force our decisions upon them.

Link to article:  http://www.press-citizen.com/story/news/local/2015/04/07/university-iowa-go-tobacco-free/25420109/

Obamacare supporters want activist Supreme Court

Regarding The Register editorial today (11/17/2014) entitled “Obamacare foes are hoping for activist judges”  Exactly the opposite is true.  It is the Obamacare supporters who are hoping for activist judges to interpret the law differently than it was written.  The letter of the law is clear.  It states that only people who sign up for Obamacare through state run exchanges are eligible to get subsidies.  Obama and his team created this threatening provision intentionally to pressure states to create their own exchanges. But more than 30 states, including Iowa, did not knuckle under to the pressure.  The Supreme Court should uphold the law as written, not as Obamacare supporters wish or hope it was written.  This is what happens when, as Nancy Pelosi famously said, “we need to pass this bill to see what is in it.”
Register editorial: http://www.desmoinesregister.com/story/opinion/editorials/2014/11/17/editorial-obamacare-foes-hoping-activist-judges/19154603/
Source video of Jonathan Gruber, Obamacare expert advisor, explaining the intentionally threatening provision:   https://www.youtube.com/watch?v=rBAHvX1WdWc

National Institute of Health – budget does not need to increase.

On 9/29/2014, The Des Moines Register reported on its front page, “The budget for the National Institute of Health… has shrunk about 20% over the past decade…”  The article went on to describe the reduction in medical research dollars flowing to the University of Iowa and Iowa State University.  What was not stated was the the reduction in spending was not a reduction in the actual dollars.  It was only after adjusting for inflation that there was any decrease.  Over the last decade (2003 – 2013) the dollars increased by $2.2 billion from $27.1 to $29.3 billion, an increase of 8%.  Adjusted for inflation, this equals a cut of about 15%.  If we look at the prior decade, (1993 – 2003), the appropriations increased from $10.3  to 27.1 billion – an increase of 164%!  Taking the two decades together, the increase is 67%.  Over the same two decades inflation totaled 61%.  So, it appears that funding has mostly kept up with inflation plus a little more.
The demand for medical research funding paid for by taxpayers is almost unlimited.  Therefore we must first decide how much we can spend, and then select research projects based on our priorities.  Maybe the research that U of I and ISU have been proposing is not as high on our priority list as other proposals.  Or, maybe we don’t have as much political power as some of the other research institutions.
Source NIH appropriations: http://www.nih.gov/about/almanac/appropriations/part2.htm
Source inflation – see table 24:  http://www.bls.gov/cpi/cpid1408.pdf