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.
It is not surprising that the Iowa Automobile Dealers Association has registered its opposition to Iowa Senate Study Bill 3139 which would allow RV dealers to sell RVs on Sundays. (See Register link below.) I’m sure they think if RV sales are allowed Sundays, then car sales might be next. It would be nice if that were true. The only reason that it remains a crime to sell RVs or cars on Sundays in Iowa is because of the lobbying power of the dealers. If RV and car sales were allowed on Sundays in Iowa, it would not require any dealer to be open for business on Sundays. The decision would be left up to the owner, just like every other business. I urge Iowans to let there elected representatives know that Iowa should stop making it a crime for RV and auto dealers to be open for business on Sundays.
On 12/16/2016, The Des Moines Register reported that the Iowa Public Information Board had ruled that Prairie Meadows Race Track and Casino was not a “government body” according to their rules and, therefore, was not required to follow open records laws, and not required to provide the Register with records pertaining contracts of its top executives. (See link below.)
The Register can appeal the decision, and has some good arguments why Prairie Meadow should be subject to open records laws. But even if Prairie Meadows is not required to follow open records laws, they could still release the records voluntarily. Just because it is legal to do something does not mean it is the right thing to do. Prairie Meadows would not exist if not for the original support of Polk County taxpayers. The board claims that Prairie Meadows is a not-for-profit organization, (even though the IRS disagrees). I don’t understand why any board member would want to be anything other than completely transparent about the operations of Prairie Meadows? I presume that none of them feel they have anything to hide.
I appeal to the board members of Prairie Meadows to simply do the right thing, and voluntarily open their records to the public, and the Des Moines Register.
Link to Register article: http://www.desmoinesregister.com/story/news/local/government/2016/12/15/iowa-board-says-prairie-meadows-records-can-secret/95492840/
The Des Moines Register recently reported that all Iowa cattle producers will soon be forced to pay $0.50 per head into a “checkoff program. The funds will be used for beef promotion, research and other activities. 56% of the cattle producers voted for the “checkoff” program – forcing the other 44% to contribute to the scheme. In any other setting, it would be called a tax.
There are many checkoff programs for a wide variety of commodities, both nationally and in various states. They all work the same way. If a majority of the producers want to tax themselves to promote their commodity, then they get to force all producers to pay into the program.
There is not the kind of activity that should be ruled by a majority. I understand that if the programs were voluntary, which they originally were, that those who did not pay would get a “free ride” – they would get the benefits without paying for any of the costs. That is not a sufficient reason to use the force of government. There are an unlimited number of things that a majority of businesses might like to do, if they could force all competitors to help pay.
Both federal and state governments need to repeal the laws which allow checkoff programs to exist.
Link to Register article: http://www.desmoinesregister.com/story/money/2016/12/08/iowa-beef-checkoff-passes-with-56-percent-approval/95138020/
As The Des Moines Register reported on 10/13/2016, “Black Iowans are seven times more likely to be arrested for drug possession than white Iowans…” (See link below.) Drug possession. A crime without a victim. Arrests that create a criminal record that seriously negatively affects a person’s ability to get a job.
Even if blacks do possess illegal drugs at a rate seven times more than whites, which I very much doubt, treating possession of any drug as a crime is clearly unfair, if not racist. Why don’t people get arrested for “possession” if they are caught with a six pack of beer? Why aren’t people be arrested and charged with “intent to deliver” if they are caught with more than a case of beer? Why aren’t people charged with a more serious crime if they are caught with high alcohol content distilled spirits, which are surely more dangerous?
We need to end the immoral and impractical drug wars. The correct and reasonable thing to do is to legalize and regulate the manufacture, sale and use of all drugs, just like alcohol, tobacco, and prescription drugs. Just like with alcohol, fair regulations would include protecting our children, and prohibiting driving vehicles while intoxicated. In any case, we need to end prohibition.
Link to Register article: http://www.desmoinesregister.com/story/news/crime-and-courts/2016/10/12/iowa-ranks-2nd-worst-racial-disparities-drug-arrests/91958452/
The Register has called for payday loans to be outlawed. (See link below.) Just know, that if payday loans are banned, people who have a need for short-term small loans will simply not be able to get one – from any legal source. Using the calculated annual rate of interest is somewhat misleading. If a person borrows $500 for two weeks and has to pay back $550, the annual rate of interest is $260%. If the maximum allowed annualized interest rate was 36%, then interest on a two week loan for $500 would be capped at $7. No legal lender will make a $500 loan for 2 weeks to only earn $7. The Register quoted Democratic Iowa Senator Joe Bolkcom as saying, “In Iowa, they would be better off getting a loan from a loan shark.” If Iowa bans payday loans, we may find out whether or not Senator Bolcom is correct.
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/