To the Editor:
Re “Four Key Things You Should Know About Health Care” (Op-Ed, nytimes.com, Sept. 12):
Ezekiel J. Emanuel and Victor R. Fuchs argue that price transparency won’t lower health care costs. Fortunately, they’re wrong, largely because they missed several avenues for how transparency will help.
Transparency should lower prices through four critical paths: better informed patients; better informed employers able to help their workers shop for value; improved ability for employers to discipline middlemen; and public pressure on high-cost providers.
Employers — actually, employees, since all the health care spending comes out of their wages — are paying rates far above hospitals’ marginal costs for providing services.
The House of Representatives this week will begin acting on a bill that would limit Americans’ access to lifesaving medicines, impede the development of new treatments for deadly and debilitating diseases, and increase health spending over the long term.
The Lower Drug Costs Now Act of 2019 (H.R. 3), introduced last week with the backing of House Speaker Nancy Pelosi, D-Calif., would double down on the failures of existing government policies that have distorted prescription drug prices and contributed to higher health care costs.
Good politics involves consistent, simple messages. Opponents of the Trump administration believe they have found one with health care: sabotage. When new numbers showed a small uptick in the number of uninsured from 2017 to 2018 (which actually resulted from ObamaCare’s own failures), Democratic presidential candidates and House Speaker Nancy Pelosi all had statements including that accusation against the Trump administration.
But they are wrong. After congressional efforts to replace ObamaCare failed, President Trump signed an executive order to expand Americans’ health care options and promote market competition. This order led to bold actions to improve the nation’s health sector and help middle-class families. In particular, the administration expanded access to more affordable coverage, returned regulatory oversight from Washington to the states and increased options for employers to offer health insurance to their workers. Many of these changes essentially reversed Obama administration restrictions that were intended to force everyone into one-size-fits-all plans.
Throughout much of last year, critics of the White House darkly predicted that Congress’ repeal of the tax penalty on the uninsured, coupled with an administration rule lifting federal restrictions on short-term policies, would lead to double-digit premium increases in 2019.
The good news is that none of that has happened. To the contrary, average premiums for “benchmark” plans—policies whose premiums are used in calculating premium subsidies—declined by about 1% in 2019, for the first time in the program’s history.
The decline was driven by seven states (Alaska, Maine, Maryland, Minnesota, New Jersey, Oregon and Wisconsin) that obtained waivers from the Trump administration to deviate from certain Obamacare mandates.
Premiums in those states fell by a median of more than 7%, while median premiums in the other 44 states and the District of Columbia rose by more than 3%.
The Trump administration’s assault on e-cigarettes is the latest move by the White House to salvage Donald Trump’s health care agenda ahead of the 2020 elections.
Turning away from the bitter Obamacare debates that have been a disaster for Republicans, Trump’s been building his disease-by-disease agenda all year, aimed at suburban voters who may be put off by the Democrats’ left turn on health care.
His 2020 campaign strategists say this is all intentional. Polls show that health care is a top issue for swing voters, but Democrats currently have the edge and Obamacare is polling at all-time highs.
Trump promised in this year’s State of the Union address to wipe out HIV transmission in the United States in a decade. At campaign rallies since then, he’s promised to lower drug costs, end the opioid epidemic and even cure childhood cancer. He’s rolled out a plan to overhaul kidney care for hundreds of thousands of Americans on dialysis and waiting for life-saving transplants. And now he’s taking on the rapidly worsening epidemic of youth vaping.
Far from proving charges that the administration has “sabotaged” Obamacare, new Census Bureau dataprovide compelling support for the president’s actions.
New numbers released this week show a sizable increase in the number of Americans without health insurance—from 26 million in 2017 to 28 million in 2018.
Democrats were quick to argue the Trump administration is sabotaging Obamacare. The truth is that the Trump administration is working aggressively to increase options for consumers to get more affordable, flexible insurance coverage, as Brian explains in his new paper, through:
- Short-term, limited-duration plans
- Health Reimbursement Arrangements
- Association Health Plans (which Democrats have sued to block)
- Flexibility for states to do a better job of helping those with pre-existing conditions, and other actions.
Drug importation is no longer a pipe dream. Now it’s a pipe bomb.
The Department of Health and Human Services (HHS) recently floated a proposal, dubbed the Safe Importation Action Plan, to allow Americans to use Canada as their personal pharmacy. In Canada, the government dictates the market through price controls, but any drug importation scheme should give Americans pause.
Remember, the Food and Drug Administration (FDA) has stated over and over again that our government cannot vouch for the safety and efficacy of Canadian medicines. Pushing this policy through would needlessly threaten patient health and well-being. And here’s a key fact that’s being ignored: It’s infeasible. Canada simply doesn’t have enough drugs to share with United States.
The so-called Safe Importation Action Plan offers two paths forward for drug importation. First, states, wholesalers or pharmacists could submit plans for demonstration projects for HHS to review outlining how they would import Health Canada-approved drugs, Second, manufacturers could import versions of existing FDA-approved drugs into the United States.
If Democrats don’t like Obamacare plans for themselves, then why did they force all Americans to buy this insurance under penalty of taxation?
Last week, the wife of Rep. Joe Cunningham (D-S.C.) went on a self-described “rant on social media” about her health coverage.
New video: Dem congressman Joe Cunningham's wife is outraged her taxpayer-subsidized Obamacare plan doesn't pay for her therapy, their marriage counselinghttps://t.co/HQLyf1g4Iy pic.twitter.com/3NXD4qD98c
— Brent Scher (@BrentScher) September 9, 2019
Amanda Cunningham’s comments echo claims by Democratic lawmakers like Reps. Alexandria Ocasio-Cortez (D-N.Y.) and Rep. Cindy Axne (D-Iowa) about the problems with their health coverage. For many members of Congress that comes via Obamacare-compliant policies sold on health insurance exchanges.
The comments raise one obvious question: If Democrats don’t like Obamacare plans for themselves, then why did they force all Americans to buy this insurance under penalty of taxation? But beyond demonstrating the bipartisan dissatisfaction with Obamacare, Amanda Cunningham’s story illustrates the larger problems plaguing the American health care system.
July’s Democratic presidential debates left seasoned health policy professionals confused, struggling to understand both the candidates’ policies and the differences among them. But working families should find Democrats’ health care debate taxing for another reason. For all their vows that Americans can obtain unlimited “free” health care while only “the rich” will pay, the major candidates are writing out checks that will end up on middle class families’ tab. The Committee for a Responsible Federal Budget believes the tax increases Sen. Sanders has proposed to date will pay for only about half of the more than $30 trillion cost of his single-payer scheme he envisions. Other candidates fare no better in realistic plans to pay for their utopian health care promises.
The latest annual Medicare trustees report highlights the program’s growing fiscal challenge and reflects policymakers’ ongoing failure to prepare Medicare for the future. Medicare’s Hospital Insurance trust fund becomes insolvent in 2026, but the program is already in trouble from a budget perspective. More than $300 billion in general tax revenue was needed in 2018 to help fund $740 billion in Medicare spending. Bipartisan legislation will be needed to put the program on a sound basis for future generations. One starting point could be proposals advanced in the president’s budget and other reforms to improve the functioning of traditional fee-for-service Medicare. Adopting premium support, which converts the current uncapped subsidy to a defined contribution, would eliminate the fee-for-service incentives that drive up spending unnecessarily. Such a reform is controversial but less dramatic than many think.