The federal government has made huge progress in lowering regulatory barriers in order to accelerate access to health care during the coronavirus crisis, including allowing patients to talk with their doctors by telemedicine visits. But one group of particularly vulnerable patients has been left out: Medicare beneficiaries needing access to infused or injected drugs that generally must be administered by clinicians in doctors’ offices or hospitals.
We need to be smart about how we use public resources to respond to the coronavirus outbreak. Two major crises are facing the country right now: 1) the negative health impact and associated deaths from the virus, and 2) the enormous economic impact of large numbers of businesses and schools shutting down.
Congress needs to wisely allocate public resources to address both and not be distracted by long-held ideological pursuits. Many people are providing advice on how to best help businesses and workers weather the storm. For health care, it is crucial to recognize that this is a public health crisis and not an issue of longer-term health financing or coverage.
On Thursday, the Senate passed a bill to increase the federal budget and lift the debt ceiling for the next two years. The Trump administration provided a list of $574 billion in savings options from the president’s 2020 budget to offset some or all of the proposed deal’s domestic and defense spending increases over the next two years. And whenever big numbers in government spending are debated, Medicare is always on the table. Early reports said that a big chunk of the spending offsets were expected to come from “Medicare savings,” including by imposing an inflation cap on Medicare Part D “reinsurance” spending. The issues is complex but the politics aren’t: The deal could have led to charges that Medicare cuts were being used to pay for more government spending.
What Bernie Sanders is proposing is not Medicare for all. It is far more generous—and more expensive. It would be funded much differently. And its relationship with private insurance would be nothing like today’s Medicare. Sanders would, in fact, replace the current Medicare program and it would effectively eliminate private health insurance. You can call it many things—from ambitious to unrealistic. But please don’t call it Medicare.
If there is one thing that tends to unite economists across the political spectrum it’s the view that the government should not give unlimited tax subsidies to employer-provided health insurance. Yet that is what we have been doing. To remedy the problem, in place of the Cadillac Tax, we should offer employers and their employees the option of a dollar-for-dollar tax credit up to the amount of the tax subsidy they have been getting through the tax exclusion. This would solve the problem economists complain about, put health insurance and take-home pay on a level playing field at the margin, and greatly reduce the incentives we all have to over-spend on health care.
Determining whether the prices for medicines are appropriate or not is critically important, which is why studies that attempt to answer this question must stand up to scrutiny. Studies that undervalue medicines jeopardize the development of future cures, while studies that overvalue medicines justify the imposition of excessive health care costs today.
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.
In an ideal world, most people would own their own health insurance and take it with them as they travel from job to job and in and out of the labor market. Some employers may have better insurance than people can find in the open market. But most employers would prefer to make a cash contribution to help employees pay their own premiums rather than provide insurance directly.
The Trump administration’s new HRA rule undoes an Obama administration action that forbade workers from using HRA funds to purchase health insurance policies offered outside their workplace. “President Trump’s new rule undoes this misguided restriction” that reduced choices for workers and especially for small businesses, White House economist Brian Blase explains. The new accounts have the potential to be transformative, much as 401(k)s were for retiree benefits, giving employees more control and portability with their health coverage.
Seniors in progressive U.S. states are choosing private Medicare Advantage plans more so than the national average even as the politicians who want to represent them talk about getting rid of the insurer’s role in health coverage.
New data from the Kaiser Family Foundation shows more than 40% of new Medicare beneficiaries in Oregon and Minnesota chose Medicare Advantage plans in 2016. And more than 36% of new Medicare beneficiaries in New York and California chose Medicare Advantage plans in 2016.