Real Health Care Reform Requires A Price Reduction Conversation

After weeks of silence, followed by news of Obamacare sabotage, health care reform policy returns to center stage. Last week, Bernie Sanders revealed his Medicare for all plan, and Republican Senators renewed efforts to repeal and replace Obamacare with a plan (Graham-Cassidy-Heller-Johnson (GCHJ) plan) that will leave tens of millions without health insurance. If it seems like American health care reform continues on the road to nowhere, it's because it does.

The Sanders plan is long on moralizing (yes, health care should be a right) and short on concrete ideas to address health care costs. The plan includes all of the usual policy proposals to lower health care costs: administrative simplicity, enhanced negotiating power with prescription drug makers, federal subsidies for health care worker training, incentives for doctors to provide better care, and making rich people and employers pay more of the costs for national health care. The only thing new about the Sanders Medicare for all plan is that now it is official.

The Graham-Cassidy et al plan put out by Republican Senators Bill Cassidy (a doctor), and Lindsey Graham is a lot like other Republican health care reform proposals of late in that it looks to reduce federal funding of health care by replacing current subsidies with smaller block grants. The bill would also reduce the amount of money the federal government gives to states to fund their Medicaid programs. But mostly the bill, if passed, will unabashedly, take health care away from millions who currently have it with no pretense of offering them anything in return. There's more awfulness to read in Cassidy-Graham, but the overarching message is that Americans do not have a right to federally funded health care.

So here we are, again, with two opposing policies on American health care reform. Meanwhile, big pharmaceutical companies continue to introduce drugs approaching or surpassing the half a million-dollar cost mark. Employers persist in maintaining health plans whose costs they cannot manage. Workers' keep on watching health care premiums eat up their small wage increases. Politicians continue to move money around from one powerful health care interest group to another. And Americans continue to fall for the you-can't-put-a-value-on-your-health and the importance of American innovation cons to justify uniquely high-priced American health care.

No Shame In the Health Care Price Game

No one disputes that
America has the highest medical care prices in the world. But in typical American fashion, some of us like being at the top of even this list. Defenders of high-cost American health care claim the costs are high because we as a country can afford it, and that that's the price tag for medical and drug innovation. But neither of these claims is necessarily true or right. Tens of millions of Americans cannot afford to pay for health care, and the high price of medical innovation shouldn't go unchallenged.

Last week there was a report about a new cancer drug with a $475,000 price tag. And it seems like just last year we in awe about a new Hepatitis C drugs that cost about $80,000 per patient. Also, just two weeks ago,
Texas Medical Center was bragging about its $50 million worth of floodgates protecting it from Hurricane Harvey. Yes, America obviously has a lot of money to invest in medical care, but is it investing it wisely, is the greatest number of people helped by these investments and who gets to make these decisions.

Until we as a nation stop picking who is going to be the lucky group to get rich off of health care (e.g., doctors, hospitals, pharma, investors) and instead decide what we are willing to pay and what innovations are worth the money, because it can't be all of them, we will never have affordable health care in America.

Every other wealthy nation that subsidizes health care for its citizens exercises control over:

  • how many physicians to employ, their training and earnings
  • what technology to invest in
  • what to pay big pharma, and
  • what prices to pay for medical procedures

Americans never have serious conversations about reducing the amount we pay doctors, hospitals, pharmaceutical companies or the limited value of some medical innovations. The primary reason we don't have these conversations is that all of the groups that will receive less money in a new health care system are powerful and will use their power to block efforts to reduce their earnings. But a second and probably more important reason we don't move to reduce health care costs by limiting what we pay to the health care industry is that Americans aren't getting the whole story about the high price of innovation and the greedy practices of hospitals, pharmaceutical companies, and even doctors.

We need more stories about outrageous health care costs and not just when some Senator proposes some half-assed health care reform plan. These stories should be on the front page of every newspaper and news website every day. Big pharma should be required to share its research and development budgets in a format that allow for like comparisons. Pharma should be required to list its drug ingredients' cost. All government funding for medical and drug research should be posted on a government website. Doctors and hospitals should be required to post the base cost of all of their medical procedures, menu-style. Doctors and hospitals should be required to post the prices they charge non-insured and insured patients, side-by-side.

Bottom line: If we don't start talking about the outrageous cost of American health care on a daily basis, we will never develop enough outrage to do something about it, and politicians will continue to switch our money around.
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