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 advocated for government operated long term care insurance in its lead opinion on 7/15/2013. (“Long-term care policies need attention”) We don’t need or want a government financed program for long term care insurance. President Obama backed out of a government sponsored long term care insurance program when he felt unable to promise that government would not some day step in and require taxpayers to subsidize the plan. We have Medicaid for the poor. That is enough. If anything, our government should encourage people to buy long term care insurance and/or to save for their own long term health care needs. Instead, our government seems content to keep interest rates artificially low so that people will borrow and spend. Low interest rates reduce the returns that insurance companies earn on their reserves, which in turn causes them to increase their long term care insurance rates. Letting interest rates rise to their natural levels would be one of the best ways for government to help improve the incomes of seniors, and help hold down the cost of long term care insurance.
Health insurance should not be considered a “human right” as the Register advocated on 1/31/2013 (Health insurance for poor is a human right). When the term “human right” is used in conjunction with a product or service, such as health insurance, (or food, or shelter, or clothing), it implies that government should use its force to take property from some people to make sure that everyone is provided with that product or service regardless of cost. Rights that require the use of force by government to take from some to give to others are called “positive rights.” Positive rights are only possible if some of the people work, create, and save their property – so that it may be taken and distributed to others.
The kind of rights that are guaranteed by the Bill of Rights of our U.S. Constitution, are called “negative rights.” Negative rights do not require any action by anyone else and do not infringe on the rights or the property of anyone else. For example, I have a right to speak , but you don’t have to listen. I can practice my religion but you don’t have to believe. I can form a union but you don’t have to join. I can open a business but you don’t have to patronize it or work for me. Negative rights are are based on the idea that we are each free individuals who own whatever property we create or acquire honestly and peacefully through voluntary social interaction and cooperation with other people.
The current question is whether or not to expand Medicaid in Iowa. The fact that most, if not all, of the funding comes from the federal government does not make it free for Iowans. Money from the federal government is not “free money.” The more fundamental question is how far do we expand Medicaid. The number of people in Iowa on Medicaid increased by 23% from 2006 to 2010. Today, more than one out of five Iowans are on Medicaid. Of course, many more people would like to be covered by Medicaid. Who wouldn’t like to have someone else pay for their health care? Governor Branstad is correct to not expand Medicaid. Instead, we should make sure that we our current spending is being used as effectively as we can.