Republican Ideas for Healthcare Reform

 

Our healthcare system is broken. As a healthcare practitioner for the last 38 years, I’ve seen the system deteriorate right before my eyes. We can do remarkable things in the operating room we couldn’t do forty years ago, but we can’t seem to deliver high quality care consistently with a personal touch like we used to.

ObamaCare has made it easier for low-income families to get healthcare insurance, but they still can’t afford the deductibles and co-pays that are necessary to actually receive treatments, especially surgery. Hospital systems are hiring physicians more and more which eliminates much of the independent private competition that thrived on providing high-quality, attentive healthcare. Now you’re likely stuck with whoever the hospital provides.

These are just a couple of examples of the decline in healthcare. But it could get much, much worse. If we ever actually go to socialized medicine, which Democrats are pushing, you’ll be lucky if you get hospitalized at all. Rationing of care is a fundamental of socialized medicine. If you’re too old, you may be denied the care you need. “Too expensive for someone your age.”

What’s the alternative to socialized medicine? Republicans have been trying to abolish ObamaCare and prevent socialized medicine, but what ideas do they have? Former Louisiana Governor Bobby Jindal, writing in The Wall Street Journal, says he has some answers to that question. Gindal says the time is now for Republican state legislatures to advance federalism while also strengthening consumer-based healthcare. He proposes several specific policies Republicans should champion and expand:

Require more price transparency

He advocates states to build on the Trump administration’s rules requiring price transparency for health plans and hospitals by including more providers, including physicians; beefing up enforcement to ensure compliance; and compiling data online in a format that allows for easy comparisons. At least nine states have built price-comparison websites for consumers, and many have or are bu8ilding all-payer claims databases for payers and employers. This will allow consumers to shop for the best healthcare values. Employers can also use this information to set reference prices for procedures, allowing comparison shopping and creating incentives for providers to become more efficient. Price transparency also increases pressure on intermediaries like health plans, third-party administrators, and pharmacy benefit managers to negotiate more effectively on behalf of their customers.

Expand scopes of practice, repeal certificate -of-need requirements, and promote cross-border licensing.

 Legal scopes of practice should be expanded so that doctors, nurses, pharmacists, therapists and other professionals can provide services up to their training and competence. What particular providers are currently allowed to do varies by state, with many restrictions unsupported by evidence of adverse outcomes. Many restrictions are dated and intentionally difficult to update to reflect advances in training, technology and research.

Certificates of need (CON) require government permission before new facilities can be built, so that such decisions are based on politics rather than market demand. New Hampshire repealed its CON program in 2016, and Florida partly did so in 2019. State-specific licensing requirements have impeded the ability of providers, especially in mental health, to care for patients remotely. As Covid expedited federal payment reforms to encourage telehealth, states should enact automatic reciprocal licensing and other arrangements to allow providers to treat patients across state lines.

Incorporate patient-based Medicaid reforms

States have been aggressive in enrolling healthier beneficiaries in private managed-care plans, but they can do more to ensure their programs are giving patients access to mainstream medical services rather than creating a separate public infrastructure. Conservatives in Washington have long fought for block grants to give states more flexibility over Medicaid, but state Republicans should maximize the flexibility they already have to try new delivery systems, cost-sharing arrangements and benefit designs.

Simplified Medicaid enrollment and renewal requirements have increased program participation, but states should encourage beneficiaries to use sliding-scale subsidies to obtain and retain affordable private coverage rather than forcing them into one-size-fits-all, all or nothing government coverage. States should adopt aggressive premium support and anti-crowd-out policies, combined with more-flexible wraparound benefit requirements, rather than unnecessarily replacing private dollars with taxpayer subsidies. The goal is to get people off Medicaid, especially as their circumstances improve.

Enforce antitrust laws to counter overconsolidation among hospitals, physicians, payers, and other healthcare entities.

Mergers in fragmented markets can result in efficiencies and quality improvements, but many markets are already dominated by three or fewer health systems. Larger systems are more able to comply with increasingly complicated and costly government regulations, but also more likely to become dependent on government funding and less entrepreneurial. These large systems are becoming “too big to fail,” developing unhealthy codependent relationships with the government agencies that pay the, regulate them, and depend on them to deliver essential program benefits.

These are just a few suggestions for improving our healthcare system. Since Democrats seem determined to push socialized medicine, it remains for Republicans to advocate more consumer-oriented reforms through their state legislatures now, and on the federal level if they regain control of Congress.

 

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