Today, we’ll discuss healthcare, since the Senate is debating their bill.
The Senate bill is similar to the House bill in many ways. Neither repeals Obamacare, but do repeal many of the mandates.
Four Senators, Paul, Cruz, Lee and Johnson oppose it so far, because the bill does nothing to reduce costs to people and employers. It is not a free market system, which we have not had in over fifty years.
If the following were added to the bill, I would find it acceptable:
First, allow insurance to be sold across state lines. This may be difficult to do, given the 10th amendment.
Second, allow Walmart, CVS, credit unions and other companies to offer insurance plans to their customers. With risk spread out over hundreds of thousands, if not millions, of customers, prices will drop. Just look at how prescription prices dropped from Walmart offering many for four bucks. It takes health insurance needs from employers, where people risk losing insurance when they lose a job.
Third, give a 2 year period for people with preexisting conditions to get insurance without a penalty. Then, every five years after that, have a three month open enrollment for preexistent conditions as a year of jubilee. In this way, those who choose not to get insurance until something serious occurs will not have that expensive monkey on their backs forever, but will pay a penalty for a few years. It gives them incentive to buy now, or take a risk of their own choice. And it will drive down costs.
Of course, a pure free market system would be awesome, but probably not attainable at this time.
How would you fix the Senate bill?
On the national level, a complete elimination of the caps on contributions to Health Savings and Flex Spending accounts, coupled with nationwide deregulation of the insurance market.
And outlawing Certificate of Need ordinances on anti-trust grounds.
At the state level (I live in Oklahoma, but this isn’t the only state with this problem), relaxing prescription restrictions for RNs, so that they can actually practice medicine on their own without needing to directly attach themselves to a doctor. Making that a federal issue would require some kind of ludicrous omnibus legislation that would create more problems than it solved, but as a state-by-state issue, it needs to be done.
Everything has to be geared toward increasing the amount of health care available. Not health insurance. Actual go-to-the-clinic health care. More opportunity to go into the business of medicine, coupled with more control for individual customers over how they use their own money to pay for it, means competition. That leads ultimately to the best care at the best price with the best availability.
Spreading the risk out over larger pools may lower premiums in the short term, but it does nothing to stop the overall trend of ever-rising premiums. Maybe premiums will go down by 25% right now, but they may be back at present levels in 5 years.
The reason premiums are ever-rising is lack of rationing. There are no limits placed on what machines or tests or drugs will be provided. Providers have no incentive to withhold certain tests or treatments because they get paid for providing them. Patients have no incentive to forego them because they don’t pay for them.
I would rather have a pure, free-market system, where people pay, and providers charge, what people can afford. But since that genie will never be put back in the bottle, it seems to me that the best alternative is to go full single-payer.
It would still be the case that individual patients have no incentive to forego expensive treatments. But at least taxpayers as a group will have some say over how much they are willing to pay for the healthcare system as a whole. When costs are so high that there is no choice but to raise taxes to pay for it, at that point people, through their votes, can say “so high, and no higher.”
Whereas now, our only choices are to pay whatever premiums are demanded of us, or forego coverage.
I have Kaiser Permanente, which seems to me the best of all worlds. They want you healthy, but also want to keep costs reasonable. I just wish KP were available everywhere.
Mormontarian:
RN’s do NOT have the training necessary to prescribe medications. No RN in any state can prescribe medications and it would be foolish to suggest that they do. (I am quoting my wife, she is very feisty, an RN with 30+ years of experience and a supervising nurse at a major Utah hospital). I think the people you may be referring to are APRN’s (Nurse Practitioners) who can prescribe in many states. They have completed some of the same graduate work as physicians.
I personally go to a nurse practitioner for my healthcare needs. She works under the direction of a physician who assists with any troubling aspects of the diagnosis. She works up the plan and prescribes any meds I need and monitors my progress. Nurse practitioners and Physician Assistants are good ways of stabilizing healthcare costs. I like it the personalized service possible with these professionals. But there are definitely times we need to see a physician. If you think you have unresolved problems or possibly need a consultation regrading the diagnosis, request a physician. But a majority of our regular healthcare needs can be resolved by someone other than a physician.
One other thing I would do.
I would break up the AMA monopoly.
Because of them, there is an artificial shortage of medical staff. They approve, !license and certify all schools and medical practitioners.
I would put states in charge of certifying schools and professionals. I would get rid of licensing and provide certification instead.
Next, I would change patent laws on prescription drugs, moving them to generic forms quicker. As it is the only difference between oxycodone and oxycontin is the latter is time released, making it safer, yet has made the company billions over many years.
Ram,
There are many contributing causes to the shortage of medical staff. The AMA has little to do with it. It may surprise to learn that few young adults want to work 12-hour night shifts through their 20’s and 30’s while dealing with human bodily fluids and diseases, while making approximately $60,000 a year. Sell real estate, the Utah market is booming and you get to go home to your spouse at night.
In Utah, multiple private schools have stepped in to provide training (AS) for future nurses, but the quality of their graduates is hit-and-miss, and many institutions are requiring four-years of training (BSN) for their RN’s. The best schools are the traditional state universities and private schools like BYU. The state and federal government has had to shut down some institutions because they were nothing more than diploma mills. Their students could not pass the basic state exam for licensure, and the students had amassed significant student loan debt.
As previously noted, medical professionals are licensed through the state at this time. So your statement on that point makes little sense to me. For personnel to move to other markets, it can take several months. The Interstate Medical Licensure Compact is an attempt to get cross-state licensure available for all medical personnel. It is promoted by the AMA.