Access to quality, affordable medical care should be something all elected officials can agree to work on because it’s something we all believe in, Rep. Westerman (R-AR) writes. The Fair Care Act has two primary goals: to increase the number of people with health insurance coverage and to decrease per person health spending. It’s a fair solution covering pre-existing conditions, tackling the cost of insurance premiums and increasing consumer flexibility.  Highlights:

  • Title 1: Private Sector Health Insurance Reforms
  • Title 2: Medicare and Medicaid Reforms that Promote Solvency and Increase Access to Health Insurance Plans
  • Title 3: Promote Transparency and Competition to Lower Prescription Drug Costs
  • Title 4: Increase Competition and Lower Costs by Discouraging Provider Monopolies
  • Title 5: Digital Health Care Reforms
Direct primary care (DPC) is fast becoming an accepted alternative to fee-for-service payment in the private market, but it has yet to find its way into Medicare. Over two-thirds of Medicare beneficiaries have two or more chronic conditions. This is a population that would benefit greatly from high quality primary care, but the program is still built on the fee-for-service model of payment, which creates barriers to low-cost, frequent communication between physicians and their patients.CMS could test ideas like DPC to see if they can deliver better care at a lower cost to the Medicare population.  

Medicare funds health-care services for 60 million elderly and disabled Americans. Of these, 39 million receive coverage through a plan known as “Traditional Medicare” or “Medicare Fee-for-Service” (MFFS) that the federal government administers directly. Increasing numbers of seniors—21 million in 2019—enroll in Medicare Advantage (MA), choosing from competing plans managed by private insurers. MA provides an incentive for plans to develop innovative care arrangements, but the rules under which MA plans operate can be restructured so that more of the efficiency gains can be passed on to beneficiaries.

Two Republican congressmen introduced proposals Tuesday designed to fix America’s health care system through a variety of market-oriented reforms. Reps. Bruce Westerman (R-AK) and Jim Banks (R-IN) say their Fair Care Act of 2019 “addresses major drivers of health care costs as well as obstacles hindering individuals from obtaining health insurance coverage.” It proposes a bevy of changes to the health care market. Many of the bill’s provisions target availability of insurance to those who otherwise lack access. It also allows would put in statute short-term limited duration plans and association healthplans, which would increase competition.  They worked closely with Avik Roy of the Foundation for Research on Equal Opportunity in developing the plan.

My colleague Dr. Robert Graboyes encourages us to instead think about how to produce better health (not health insurance—not even health care) for more people at a lower cost, year after year. This requires allowing and fostering the kind of revolutionary innovation in the health care industry that we’ve seen in other fields, like information technology. It requires allowing consumers to choose treatments, even high-risk ones. But it also requires innovation in the provision and payment of health care.

For instance, advancements in gene therapy and personalized treatments could one day offer a cure for cancer or disorders currently considered incurable, sometimes with only a single injection. In 2017, the Food and Drug Administration approved its first gene therapy treatment, Kymriah, for acute lymphoblastic leukemia. The FDA expects 10 to 20 cell and gene therapy approvals annually by 2025.

CNN and NBC exit polling last November showed a huge Democratic advantage on health care. But socialized medicine wasn’t on the ballot.

As for 2020, Democrats know people don’t want socialized medicine, so they have been calling it “Medicare for All” even though the prototype legislation ends Medicare along with private insurance. Consumers may be starting to figure this out.

The president applauded the rollback of a key portion of the Affordable Care Act, which he has called a disaster. He called for protections for people with preexisting conditions, though his administration has worked against keeping them by trying to eliminate Obamacare. He pledged to bring down the price of prescription drugs and called for childhood cancer funding, earning some applause from Democrats. But Trump also called for halting the spread of HIV transmission before 2030 — even though his previous budgets have proposed slashing money from government initiatives in that area.

President Trump spoke out on Wednesday against surprise medical bills, highlighting an issue that has received bipartisan concern in Congress. “The health care system too often harms people with some unfair surprises … medical bills and the like,” Trump said. “We’re going to stop all of it, and it’s very important to me,” Trump added. Sen. Bill Cassidy (R-LA) unveiled bipartisan legislation to end surprise medical bills in September, Sen. Maggie Hassan (D-NH) has legislation on the topic as does Rep. Lloyd Doggett (D-TX) in the House. 

The Health Care Choices Proposal would block-grant to each state its federal share of health care funding. When combined with their own health care resources, states would have the authority to determine how best to help their unique populaces obtain insurance. This private-insurance based program would give patients more choices—at multiple price points—to customize a health insurance plan that works best for their unique situation. It would empower employers, families, and individuals with expanded choices and premiums up to 32% lower.

As we head toward the end of the year, biopharmaceutical companies are announcing their pricing strategies for 2019.

Merck & Co. raised the list price of five drugs, including its blockbuster cancer treatment Keytruda, in November — raising the price of Keytruda by 1.5 percent and its human papillomavirus vaccine Gardasil by about 6 percent. The other three treatments that saw increases were vaccines.According to Merck, the average net price of their drugs declined 1.9 percent in 2017.