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Enhancing Competition Can Offer a Better Solution Than Only "Medicare for All"

Posted by Chip Block on September 23, 2019 10:25 AM EDT
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Building on the previous blogs from colleagues, the political polarization around the healthcare and health insurance issues hides the possibility of a "hybrid" type of.....

....solution.

And it is clear that leveraging the private sector and increasing competition for improved quality of services, better results and health outcomes and improving value in terms of quality, access and costs should be a part of the ongoing formula.  And a necessary element in any healthy debate, whether the context is politics or innovation or economics.  Even with today's Medicare formulation, there is plenty of healthy competition on the Medicare supplements, Medicare Advantage plans and the overall Medicare enhancements spectrum.  

Providing basic coverage such as Parts A and B, and enabling competition on other features such as Part D and on rewarding healthy behaviors seems like a model to consider-especially when the broader market would be potentially healthier due to the younger aged participants-versus true Medicare whose participants are inherently "of age" and by that demographic feature alone are more risky than the population at large.

That said, I would fall on the side of the argument that says use much more competitive levers-but accept that a portion of the population will not be able to afford enhanced coverage features, so use elements of competition (rewards, recognition, jobs etc.) to drive healthier behaviors and better healthcare education and consumption.

Recently, I read a strong-albeit-conservative op-ed piece that was published on Wednesday, September 11th in The Virginian-Pilot's Opinion section.  It was written by the former editor of The Daily Press, Digby Solomon, who writes a weekly column for the newspapers.  I'll capture key points of his op-ed column using "quotation marks".  The title of his op-ed column on this particular day was "Competition remains the best hope for health care".

"ADD STATE sn. Lee Carter of Manassas to the list of politicians promising taxpayers something for nothing, with a proposed bill to cap insurance co-payments for insulin medication at $30 per month".

"As with most easy political solutions, his idea is short on economic reality and aims at the wrong target in what has become a real dilemma for some diabetics".

After  making a strong case that the pharmaceutical manufacturers have raised their prices to extreme and pinning the solution on the insurance companies misses the point of focusing on the root cause-untethered increases in prices from manufacturers and a healthcare consumer population that doesn't have transparency to costs and are not educated on other alternatives to the most expensive pharmacy products.

He goes on to write:

"The real solution is a concept alien to most big-government proponents: competition.  There are generic alternatives cheaper than brand name insulin.  Government could also streamline approvals for other competitors to further drive down costs".

"Requiring benefit managers to fully reveal all details of their discounts would help.  So would consumer education on cheaper alternatives".

He concludes his argument with this statement:

"The richest 1% of Americans a;lready pay 37.3% of income taxes.  And much of their money comes not from paychecks, which the government can easily tap, but from investments that can be moved offshore out of Uncle Sam's reach".

While the points that are made are salient ones, the ultimate argument still rests with the reality that until we find better, more effective, convenient and lower-cost "preventative" solutions to improve population health through better lifestyles, stronger "organic recovery" from chronic health issues and recovery procedures, then much of this argument as well as the ones focused on political solutions-may be academic.

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