Contrary to the Register Editorial on 12/1/2019, we should not add long-term care as a new benefit under Medicare. (See link below to The Register’s Editorial urging Medicare coverage of long-term care.) If we want to solve problems using the force of government, we should do the minimum needed to solve the problem. In this case, the problem is making sure that people receive medically necessary long-term care, not making sure that money is left to people’s heirs.We currently have a pretty good situation: Many people voluntarily purchase private long-term care insurance. Many others who could afford insurance choose to take a risk and not buy it. Taxpayer-funded Medicaid covers the cost of long-term care for those who are unable to pay. For those in the middle – not on Medicaid, but who would struggle to pay for private long-term care insurance – Medicaid already goes a long way to help them qualify for long-term care coverage. For example, if one spouse of a married couple needs long-term care, the other spouse gets to keep a house and a car and some income, even though Medicaid pays for the long-term care of the first spouse.The best long-term, sustainable solutions to our problems is to give voluntary, free choice to people and then expect them to be responsible for their decisions. To the extent that we allow our government to force everyone into one-size-fits-all welfare programs, there will be ongoing, unsustainable frustrations, disagreements, and dependency problems.
Recently, Gloria Mazza wrote, (and other Iowa Republicans signed), an essay in The Des Moines Register that urged President Trump and Iowa’s Republican Senators to oppose recent proposals by the Centers for Medicare and Medicaid Serivces (CMS) that would have taken reasonable steps to reign in increasing drug cost under Medicare Part D. It has now been reported that CMS and the Trump administration have backed off of important parts of the proposed changes.
Currently, Medicare Part D regulations require patient access to “all or substantially all” medications within “six protected classes” of drugs regardless of price. (Protected classes include drugs for HIV, mental illness, cancer, epilepsy, and organ transplants.)
Among other things, the proposed new rule would have allowed Medicare Part D plans to exclude a drug from coverage, 1) for an existing drug if the price increased more than the rate of inflation, or 2) for a new drug if it was simply a reformulation of an existing drug. Apparently, lobbying efforts were successful in getting these two provisions removed from the final new rule.
We don’t have a free market for prescription drugs under Medicare Part D. We should not allow drug makers to set their own price and still require coverage. It is unfortunate that the Trump administration caved-in to the lobbying pressure.
Link to Register essay by Gloria Mazza: https://www.desmoinesregister.com/story/opinion/columnists/2019/05/16/pro-life-advocates-dont-reduce-medicare-part-d-protection-drugs-congress-chuck-grassley-joni-ernst/3685349002/
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.
The Register recently criticized our fee-for-service health care payment system for causing over-utilization and for driving up health care costs. (2/12/2015 – “Florida, home of medical scans — and scams” – see link below) They gave examples of doctors ordering unnecessary test because they get paid more for every additional service that they provide. They advocated paying physicians a salary like Mayo Clinic does, so that doctors, “…have no personal, financial incentive to provide unneeded care.” They urged the Obama administration to, “…continue to work toward reimbursing providers based on quality instead of quantity while fairly reimbursing them.” I agree with the Register that, “Ultimately, reducing the overuse and misuse of health care falls to patients.” They urge patients to not rush to the doctor for every ache, ask questions when doctors order tests, resist clinic staff who want to schedule tests and procedures.
One thing the Register failed to mention is the importance of patients being required to pay out-of-pocket for some portion of their health care costs. To the extent that patients are not required to pay for some portion of their costs, they will not question the recommendations of doctors and other providers and they will tend to over-utilize health care. Requiring patients to make some out-of-pocket payment will also help reduce fraud, since patients won’t want to pay part of any fraudulent charges that billed to their insurance. Many insurance policies under Obamacare do seem to have significant deductibles and co-payments. That will go a long way to help keep down health care costs.
Link to Register article: http://www.desmoinesregister.com/story/opinion/2015/02/12/florida-home-medical-scans-scams/23278965/
Thanks to the Des Moines Register for printing the editorial by Peter Morici on 2/16/2013. (Obama blackmailing taxpayers to stick blame on Republicans – see link below.) President Obama and other politicians and pundits who say the sky will fall if the sequestration cuts are allowed to go into effect are using misleading fear tactics. Politicians at all levels of government who don’t want to see spending cuts always say that the services that will be cut are those that are the most needed and the most visible. Examples include President Obama’s statement in his State Of The Union address: “These sudden, harsh, arbitrary cuts would jeopardize our military readiness. They’d devastate priorities like education, energy, and medical research. They would certainly slow our recovery, and cost us hundreds of thousands of jobs.” Agriculture Secretary Vilsack has warned us that layoffs of food inspector will result in food shortages. A top general stated that troops in Afghanistan will have their stay extended because there won’t be enough money to train replacement troops. Homeland Security Secretary Napolitano said the we should expect increased wait times in airports due to mandatory furloughs of security staff.