By MARILYN M. SINGLETON M.D., J.D
In an entertainment venue called the “Escape Room,” participants are locked inside a themed adventure room, and they must figure out how to escape. Themes include prisons, KGB interrogation, and hostage situations. Perhaps a new theme could be ObamaCare.
Despite a large majority of Americans reporting healthcare as their number one concern, Congress does not have the political appetite for a serious assessment of the Affordable Care Act. It’s time for Congress to say, “ACA and its ‘fixes’ are not working; cut our losses and move in a different direction.” New proposals should focus on reducing the cost of pharmaceuticals and medical services rather than shifting costs from one entity to another via mandated insurance benefits and government subsidies.
Dear Congress, please act on a few simple reforms that will help everyone and hurt no one—except the drug lobbies and middlemen.
First, seniors must demand to be treated like thinking adults—and save the federal government money in the process. Under current law, anyone age 65 and over who is entitled to Social Security benefits is automatically entitled to “free” Medicare Part A (hospital coverage). But if a senior wants to decline Part A and seek or keep other medical care options he must forfeit his Social Security benefits. As Judge Rosemary Collyer noted in a legal challenge to this rule, “plaintiffs are trapped in a government program intended for their benefit. . . They disagree and wish to escape.” Alas, the 1993 regulation was interpreted to confirm the draconian punishment for wanting to break free of the government control. To right this wrong, will one brave congressperson or senator revive the Retirement Freedom Act and support the Medicare Patient Empowerment Act that makes it easier for patients and physicians to opt out of Medicare?
Second, seven of ten Americans use prescription drugs, and they overpay for these 23 percent of the time. Patients often aren’t told they could pay less by not using insurance. If the insurance co-pay is higher than the actual cost of the drug, the middlemen (pharmacy benefit managers) keep the difference.
Legislative remedies exist. The bipartisan Patient Right to Know Drug Prices Act prohibits health insurance issuers and group health plans from restricting or penalizing pharmacies who tell enrollees the differential between a drug’s cash price and the insurance plan’s cost. The bipartisan Know the Lowest Price Act of 2018 prohibits health plans and pharmacy benefit managers in the Medicare Advantage program from restricting pharmacies from informing individuals regarding the prices for certain drugs. The bipartisan Transparent Health Pricing Act requires entities that furnish health-related products or services to the public to disclose the wholesale, retail, and discounted prices for those products and services at the point of purchase and on the Internet.
And when the price of brand name drugs has increased 10 times more than inflation, dear Congresspersons, consider supporting the Competitive DRUGS Act prohibiting name brand drug companies from compensating generic drug companies to delay a generic drug’s entry into the market.
With regard to medical services, the Direct Primary Care (DPC) model is burgeoning as patients yearn for quality time with their doctor at an affordable price. Here, all primary care services and access to basic commonly used drugs at wholesale prices are included in a fixed transparent price. Congress should support the Primary Care Enhancement Act, a one-page bill that allows Health Savings Accounts (HSAs) to be used to pay enrollment fees for DPC practices. Many Medicare beneficiaries prefer this model as they remember the era when patients actually knew their doctors.
Moreover, the DPC model saves federal dollars. Prescription drugs accounted for $110 billion in Medicare spending in 2015, 17% of all Medicare spending. With DPC dispensing, the cost of pharmaceuticals can be as much as 15 times lower than pharmacy prices. And Medicare spent $17 billion on potentially avoidable hospital readmissions. DPC’s better coordination of chronic care decreases hospital admissions.
Numerous bills designed to give patients more control over their medical care include provisions that: increase the maximum HSA contribution; allow Medicare eligible individuals to contribute to HSAs; allow members of healthcare sharing ministries to participate in HSAs; and allow individuals who participate in DPC practice, or who receive care from an employer’s onsite medical clinic to participate in HSAs.
Physicians want freedom to do the best for their patients and patients want good care at affordable prices. Will Congress act or continue to let such liberating legislative opportunities wither away?