Health care economist John Goodman and the Heritage Foundation’s Marie Fishpaw used an op-ed in the National Review to discuss five ways to promote more patient-driven, high-value health care. Health care reform is the number one issue voters would like to see Congress take on. The government shouldn’t mandate anything new but pass legislation to facilitate more choices for the American people:
- Personal and Portable Health Insurance – for someone who suffers from a pre-existing condition, the main problem arises when they might need to move jobs. They do not own their insurance; the employer does. A new employer plan may choose not to cover the pre-existing conditions, which often leads to job lock or denial of coverage. The Trump administration has taken action to increase the portability of health insurance by reforming the way employers can use health reimbursement accounts (HRA). The authors encourage Congress to codify this change and give states the power to control their insurance markets to a larger extent and offer more products.
- Round-the-Clock Medical Care – the lack of emphasis on primary and preventative care leads to lower overall health and prolongs treatment of expensive conditions. One way to increase the use of primary care to keep people healthier is to promote models that allow around the clock access to one’s primary care doctor. Direct primary care (DPC) is one way to do that. Direct primary care removes the third-party payer from the delivery process, which elevates the doctor-patient relationship and leads to more personalized care. Congress can work to include these arrangments in Medicare and Medicaid because the monthly DPC fee will produce significant cost savings and improve health outcomes.
- Access to Telemedicine – there are a significant number of areas in America where the number of physicians is not enough to adequately provide services to the nearby population. One way to bridge this gap is to use telemedicine, the process of delivering care at a distance through telecommunications. Congress can increase the use of this technology which connects patients to doctors in ways previously unavailable to the system by removing the restrictions of when Medicare and Medicaid can pay for telemedicine. States can also reform licensure laws to allow out of state doctors to see their state’s patients via telemedicine.
- Access to Centers of Excellence – the authors describe a “race to the bottom” after Obamacare was signed into law. The insurers now look for the healthiest people and try to avoid the sick. To give those who need the most medical care access to the best providers, Congress needs to act to give states the authority to reform insurance markets and eliminate insurance mandates. Only then can states create ways for the very sick to have a wide range of providers, incentivize providers to want to treat these patients, and allow insurers to be profitable from treating this population.
- Patient Power – in most of the health care delivery process, patients have very little say in cost negotiations and choice of providers. Increasing consumer power in healthcare purchasing will affect the market greatly because patients will have a better idea of what goes on behind the scenes in the normal way of purchasing health care through a third party. One way to do this is to increase the use of health savings accounts (HSA). Managing your care and paying for it through an HSA could provide a more personal and effective approach to treating chronic diseases. Here is how the authors say we can increase the use of HSAs:
To take advantage of the full potential of HSAs, we need three policy changes: (1) People should be able to use completely flexible HSAs, wrapping them around any health-insurance plan and using them to pay for any medical costs the plan does cover; (2) they should be able to use their HSAs to pay premiums as well as out-of-pocket expenses; and (3) health plans should be allowed to have “shared savings programs,” where enrollees who choose better and cheaper care get to keep their share of their savings in their HSA.
The Trump administration recently made a major announcement with respect to the first of these changes. Going forward, employees with HSAs will be exempt from the high-deductible requirement for the treatment of chronic disease. This means that the employer or insurer will be able to provide first-dollar coverage for some services without running afoul of HSA regulations.
Empowering patients with choices and control over their healthcare is an important part of the broader health care reform that needs to take place in this country. The list above compiled by two scholars on the issues would greatly shift the power back to patients and away from the government.