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 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.
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.
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.
According to a report in the Des Moines Register today, 10/26/2015, the last bird flu outbreak cost taxpayers $1 billion. (See link below.) The payments to chicken and egg producers included the cost of the birds that were destroyed, the cleanup, and “indemnity payments” to cover their losses.
I understand that we citizens, through our government, need to prohibit diseased meat from entering our food supply. I don’t understand why producers are not insured against such a foreseeable risk. If we have a law that prohibits diseased meat from being sold, and if we do not provide producers with a taxpayer paid bailout, then producers will do one (or more) of three things: they will reduce their own risk by splitting large flocks into smaller, geographically separated flocks; they will buy insurance to cover the risk; or they will take the financial risk of loss upon themselves.
To the extent that taxpayers bail out producers, they will not take the necessary steps to manage and reduce their own risks. We need to give notice to producers that they will not be bailed out in the future.
Link to Register article: http://www.desmoinesregister.com/story/money/agriculture/2015/10/25/bird-flu-when-return/74334080/
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/
Some of the people in my industry, home medical equipment (HME) dealers, think it would be a good thing if all HME dealers in the state were required to be licensed by the State of Iowa. They lobbied Senator Jeff Danielson who agreed to propose Senate Study Bill 1172 (SSB1172) which, if passed, would require such licensing. I am not aware of any patients who are calling for this. I’m not aware of any particular problems in our industry that have resulted in harm to patients. Almost all HME dealers are providers under Medicare, and Medicare requires all providers to be accredited by an independent accrediting agency. The purpose of accreditation is to help ensure that all services and products are provided in a safe and appropriate manner. It does not appear that licensing is needed for the safety of the public. Therefore, I presume that those who advocate for this bill are hoping is will help protect existing HME businesses against new competitors.
I think they learned about this political technique for protecting existing providers against competition from the orthotists, prosthetists, or pedorthists in Iowa. What’s that? You say you don’t know what an orthotist, or a prosthetist or a pedorthist is? They are medical professionals who, only a few years ago, successfully lobbied the Iowa Legislature to require a license to practice their profession in Iowa. (You’ll need to look them up.) The effect has been that many DME dealers are now prevented from selling specially fitted shoes to diabetic patients because they do not have the proper pedorthist license. I had never heard of pedorthists until we found out that we had to have a licensed pedorthist in order to continue to sell diabetic shoes. I had never heard of any complaints from the public, or of any public safety issues surrounding the sale of diabetic shoes by DME dealers. Again, I presume that the existing businesses were trying to protect themselves against new competition for DME dealers.
Professional licensing in Iowa is out of control. Any group that wants to prevent new competitors from entering their industry goes to the state to become a licensed profession. This not only needs to stop, it needs to be reversed. As the Des Moines Register has advocated, we need to go through all licensed professions to determine whether or not there is a real public safety concern that is actually solved by licensing. If not, we need to repeal the licensing requirement. If there is a real public safety need, then we need to make sure that the licensing requirement is limited to meeting that need, and that it does not go beyond that need in order to protect existing providers from competition.