RACHNA SHAH, PUSHING FORWARD
National health expenditures have been rapidly increasing since 1960 and, despite a recent reduction in this pace, growth has rebounded since 2014. Prices of medical services are among the greatest drivers of this growth. Obamacare, or the Affordable Care Act, has recently been enjoying great popularity. The ACA was not devised to be the end goal of healthcare reform, but rather was a step in the right direction. Healthcare should not be a political matter steeped in polarization – it should be one built on compromises and collaboration for our collective prosperity and health.
First, one must consider malpractice reform, also known as medical tort reform. Defensive medicine and unnecessary procedures and tests are ordered on a daily basis to shield the healthcare professional from potential lawsuits. Enforcing a maximum cap on “noneconomic” damages could begin a compromise between doctors and the government to adapt to other cost-saving measures in the healthcare system. While malpractice policies exist on the state level in almost half of the states, they do not on the federal level. H.R. 1215, the Protecting Access to Care Act of 2017, would cap noneconomic damages at $250,000. The Congressional Budget Office estimates would reduce deficits by approximately 50 billion dollars over a 10 year period. If and when a healthcare professional causes injury to a patient, the patient can take legal action against the professional. Compared to many other countries, patient compensation is generally higher in the US, where medical malpractice most often involves tort lawsuits. As opposed to criminal law, tort law can be based on negligent actions and it has a lower burden of proof – preponderance of evidence rather than beyond a reasonable doubt. Reform cannot solely occur in the legal sphere, but also in the medical one. Improving patient safety should also be a high priority, so that malpractice lawsuits can be avoided to the greatest extent possible.
Second, the drug cost dilemma must be critically managed and evaluated. A 2016 survey by the Kaiser Family Foundation found that 82 percent of Americans support Medicare having the power to negotiate drug prices. It is as simple as that—drugs, especially life saving ones that people rely upon and thus have inelastic supply, must be fairly priced. Stronger antitrust policies would bring generics as opposed to brand name drugs into the market faster, resulting in lower priced drugs. Making value based decisions for pricing is essential, especially when more reasonably priced drugs and alternative treatments may exist. According to several studies, Americans pay higher prices for prescription drugs than any other country. This is not limited to striking examples, such as Mylan’s EpiPen two-pack epinephrine auto-injectors. The federal government should also have the ability to negotiate planned price hikes with drugmakers, such as Mylan, like the State of Vermont. Under current law, the United States government cannot negotiate drug prices for Medicare and Medicaid. At the same time, several drug companies charge much lower prices abroad. Adopting a “most favored customer clause” or a “best price” clause would force drug companies to charge similar prices to the domestic and overseas markets. Research and development for drug companies is incredibly time consuming and costly, given the necessity to ensure that the drug is safe and effective on a variety of sub-populations. Nonetheless, the United States and its consumers cannot take on the burden of research and development costs by ourselves. Yet, neither can drug companies. Many pharmaceutical companies argue that the fault lies with insurance companies, who are overcharging consumers for deductibles and co-pays. Among the top medical billing challenges that contribute to this are coding inaccuracies and failures to collect important patient information at the beginning of the care process.
Third, and perhaps most importantly, is careful consolidation. Hospital mergers have resulted in certain regions being dominated by a healthcare system, whether it be UPMC in Pittsburgh or the Yale New Haven Medical in New Haven. Hospitals have also grown in acquiring private physician practices, lab work, and insurance companies. This is often refused as caring for the whole patient, a system that would cut down on unnecessarily high profit margins through billing and overhead costs. Consolidation is projected to improve health outcomes, but if it reduces competition, evidence shows that quality and costs have respectively gone down and increased rather than the other way around. More transparent reporting and disclosures would allow it to be determined whether or not these mergers are socially beneficial. Consolidation, however, is not limited to large-scale ventures, but also to ones within the hospital. Effective team-based health care allows health providers to work with the patient, their family and/or their communities, to achieve the best health outcomes possible. High-performing teams are already seeing successes as all have the shared goal of supporting the patient, and thus, each of their actions is centered around the patient and their priorities.
While the current political arena may seem gridlocked and polarized, bipartisan support for healthcare is not impossible. It is only through cooperation that we can improve the state of national healthcare – and pass a bill through Congress.