Senate HELP Committee leaders Wednesday unveiled their wide-ranging bill to address health care costs including “surprise” medical bills. [While surprise medical bills are a serious problem and the goal is laudable, Congress has tried in the past to address this issue, leading to unintended and expensive consequences. All of the proposals before the HELP committee are controversial, and Congress must proceed carefully to avoid exacerbating the problem.]
While Washington debates whether the “rebate rule” proposed by the Trump administration would cause federal spending to rise, too many are forgetting the people it would help. The rebate rule would convert rebates on brand-name prescription drugs—paid by pharmaceutical companies to health insurance plans—into upfront discounts—shared directly with patients at the pharmacy. The rule affects seniors and low-income Americans in privately run Medicare and Medicaid plans, but the administration wants Congress to extend the same protection to all Americans with private insurance. This is the quickest way to lower consumers’ out-of-pocket costs for medicines—by billions each year. It’s also a once-in-a-generation opportunity to reset our system to work better, for all patients.
Single-payer health care is a dividing line in the race, separating Democrats who want to replace the private insurance system from those who favor improving it. Some candidates — like Bernie Sanders and Michael Bennet — picked a clear side. Others, like Elizabeth Warren and Kamala Harris, took a middle path.
Despite all the hoopla about Obamacare and its individual plans, most working-age Americans still get their health insurance through their employers. And as countless health wonks have noted, there are lots of problems with that. Employer offerings are limited and are not portable when people switch jobs. And the tax advantages that perpetuate this situation distort the economy: They encourage companies to offer more and more compensation in the form of health benefits, and they are unfair to workers without access to employer plans.
Rising support for socialism in the United States comes at a time when politicians like Sen. Bernie Sanders, I-Vt., promise a great many “free” services, to be provided or guaranteed by the government.
Supporters often point to nations with large social programs, such as Canada, the United Kingdom, and the Scandinavian states, particularly when it comes to health care.
Never mind that these are not true socialist countries, but highly taxed market economies with large welfare states. That aside, they do offer a government-guaranteed health service that many in America wish to emulate.
The White House should consider building on the HRA rule by requiring that all newly incorporated businesses seeking the tax break for employer coverage do so through HRAs. Such a reform would preserve traditional employer-based group health insurance for those who have it, while ensuring that start-ups that evolve into the Googles and Apples of the future deploy the new model.
Of all the things we might do to improve our health care system, the one reform that is more important than any other is almost never discussed.
It is ignored by Republicans. By Democrats. By the experts. By the think tanks. And by just about everybody who has an opinion on health policy.
Here it is: If we want the system to work well, we must make it profitable to take care of sick people.
Last Thursday afternoon, the Trump administration released its final rule regarding Health Reimbursement Arrangements (HRAs). The 497-page document will take lawyers and employment professionals weeks to absorb and digest fully. But in a nutshell, the rule will help to make coverage more portable and affordable—while also going a long way to resolve the problem of pre-existing conditions.
Medicare for All has become a litmus test in the Democratic Party, but some leaders — including House Speaker Nancy Pelosi and former vice president and current presidential candidate Joe Biden — are wary of the political consequences of stripping private insurance from the 180 million people enrolled in job-based coverage. They are pushing a “public option” as a less threatening alternative.
A public option is sold as less disruptive than Medicare for All but it would have similar results, and a similar destination. If enacted, private insurance would wither, competition would decline, innovation would slow, and the costs of health coverage would be hidden inside ever-rising tax bills.
The most recent KFF Health Tracking Poll finds majorities across partisans think taxes for most people would increase under a national health plan, sometimes called Medicare-for-all (78 percent), and about half (53 percent) think private health insurance companies would no longer be the primary way Americans would get health coverage under such a plan.