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.
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.