Two recent news stories tell the tale about how Congress should go about fixing health care and how it should not. Two factors differentiate a new Medicare experiment here from the reckless American Health Care Act: thoughtful analysis and an actual desire to make health care more affordable and more available.
That’s the holy grail of health care reform. It’s the target that the Affordable Care Act aimed at – not entirely successfully – and it’s what remains desperately needed in a country where the costs of health care are approaching 20 percent of gross domestic product.
That is to say that without some change, Americans will soon be spending $20 of every $100 on health care, leaving less for housing, food, clothing, education and anything else they might want to buy – vacations, concerts, cars and more. It’s unsustainable.
Part of that bloated health care cost has long been driven by uninsured people seeking primary care in hospital emergency rooms, where costs are at their highest. The ACA, known as Obamacare, did make a dent in that problem by providing insurance to millions of Americans who had none before. But the costs of the coverage are high and, while the law helped to moderate the cost increases, they are still rising faster than the country can afford.
That’s where a new Medicare experiment may make a difference. Bipartisan federal legislation passed two years ago aims to lower medical costs for Medicare patients by changing how physicians are paid while simultaneously improving patient care. Insurers and health care professionals are both excited about the possibilities.
Under the initiative, Medicare would pay physicians based on the number of Medicare patients they see and the quality of care they provide, not on the number of services they provide. That’s a change with consequence.
The approach will give physicians a guaranteed income for the Medicare patients they see while allowing them to design their practices to operate better. Instead of repeatedly calling Medicare patients in for visits, doctors and other health professionals will collaborate to develop a comprehensive plan for each patient.
Thus, as one physician observed, a diabetic’s medical team might include a doctor, a nutritionist and a pharmacist.
This is a creative plan that seeks to improve care and lower costs. How it plays out, time will tell, but it aims at the right target.
The puzzle is that while this pilot project was approved by a Republican-dominated Congress, the House of Representatives – also controlled by Republicans – eagerly passed a measure this month that would drive 23 million people off the insurance rolls, according to the Congressional Budget Office.
And despite President Trump’s promises to the contrary, the bill would drive up premiums for Americans with pre-existing conditions such as diabetes and cancer – “if they could purchase [insurance] at all,” the CBO report said. It would shrink the federal budget by cutting Medicaid, the health care program for the poor, by $834 billion, and by reducing subsidies for people who buy insurance on the exchanges.
This bill is neither creative nor helpful to health care and, worse, its aims are furtive: Its savings would be diverted to fund a proposed tax cut that would disproportionately benefit the wealthy. It is, in a word, dishonest.
The good news is that the Senate is highly unlikely to pass the bill. What it should do is start from scratch, understanding that there is national value in ensuring that Americans have access to good health care, then figuring out which parts of Obamacare to keep and which to change, all with an eye on reducing costs, improving care and keeping Americans healthy.