The Kaiser Family Foundation (KFF) Health News reports that many Trump voters are skeptical of Republican health care orthodoxy. Purportedly, it is not just independent voters who question what KFF describes as the hands-off health care policy agenda. Even voters who supported Republican candidates long before Trump want government to lower their medical bills, saying:
But as Trump begins his second term, many of the voters who sent him back to the White House welcome more robust government action to rein in a health care system many Americans perceive as out of control, polls show.
“That idea that government should just keep its hands off, even when things are tough for people, has kind of lost its sheen,” said Andrew Seligsohn, president of Public Agenda, a nonprofit that has studied public attitudes about government and health care.
The challenge for Republican reformers is how to reconcile contradictory views of restraining government meddling in health care with voters’ desire for help holding down medical bills and limiting cost-sharing. In many ways the problem is irreconcilable. Patients want no limits on their care, but do not want to pay excessive medical bills. More from Kaiser Health News:
For years, Republican ideas about health care reflected a broad skepticism about government and fears that government would threaten patients’ access to physicians or lifesaving medicines.
“The discussions 10 to 15 years ago were all around choice,” said Christine Matthews, a Republican pollster who has worked for numerous GOP politicians, including former Maryland governor Larry Hogan. “Free market, not having the government limit or take over your health care.”
Republicans historically tried to turn patients into consumers, who comparison shop for better prices. There is nothing wrong with that. Indeed, a healthy dose of consumerism is precisely what the medical marketplace needs. The problem for many of Trump’s voters is that market failure has made it difficult to be a consumer. Many patients do not realize they can shop, or that they are supposed to shop. Consumers need the tools to easily compare prices, and the lack of transparency makes it difficult to know prices prior to the service.
Over the years my doctors have worked with me to hold costs down when I let them know I was enrolled in a high-deductible health plan. However, private equity firms increasingly own physician practices, while many doctors are also employed by hospitals. It is not clear that patients can depend on their doctors to advocate on their behalf when their physicians work for employers with revenue targets who demand costly referrals. Hospitals, drug makers (even insurers) often work to prevent patients from exercising consumer sovereignty.
Republican lawmakers are uncomfortable intervening in the health care marketplace. For instance, Republicans opposed allowing Medicare Part D the authority to negotiate drug prices for medications seniors use. That is at odds with some voters who welcome lower prices.
Republican voters strongly back federal limits on the prices charged by drug companies and hospitals, caps on patients’ medical bills, and restrictions on how health care providers can pursue people over medical debt.
For their part, Democrats’ solution to costly medical bills was health coverage. Obamacare did not make health care affordable, it only shifted costs. Moreover, health coverage does not make medical care affordable. It just spreads the costs to others and changes how care is paid for.
A few simple ideas that both parties can agree on include several concepts that are already in progress. Price transparency in ways that are useful would go a long way in boosting consumerism. Requiring accurate price quotes in advance should be required to establish a meeting of the minds (i.e., mutual assent) before an agreement is enforceable and a debt collectable. The FTC has been slow to prevent consolidation in the industry for medical services. Only recently has the FTC become more aggressive in battling market consolidation. It’s even been suggested that special medical courts could be used to settle medical billing disputes. Historically state courts have sided with providers’ use of blanket financial responsibility forms. In addition, the independent dispute resolution panels have sided with out-of-network providers about 75% of the time. One thing is clear, however, voters want action rather than rhetoric.
Read more at: Republicans Once Wanted Government out of Health Care. Trump Voters See It Differently
Thanks for posting.
I have a new article coming out on “Eight Reforms to Wipe Oot Medical Debt.”
I too am disappointed that the idea of patients as consumers did not succeed. In my experience, patients as consumers works well for people who make and have a lot of money.
It does not work for people who are broke.
The independent dispute resolution panels have awesomely not succeeded. I’m going to have to study this.
“Requiring accurate price quotes in advance before a debt is collectable” is a desirable goal, but it is completely at odds with the way that all hospitals and many specialists actually run their businesses. Hospitals want and may in fact need the patient to be admitted rapidly.
I am on Medicare Advantage in MN. 100% of hospitals and about 90% of all doctors in the state are in my plan. All these entities have agreed to accept the insurer’s payment rates. There are never any surprises.
I could be forgiven for thinking that ‘Medicare Advantage for all’ is a desirable goal.
Here is what I was trying to get at……
”
“People with Medicare Advantage plans that have networks are also protected from out-of-network surprise and balance billing in several ways—enrollees may not be charged more than in-network cost-sharing for emergency and urgently needed services, including stabilization, medically necessary dialysis when the enrollee is outside of the plan’s service area, or services provided by an in-network provider who works with out-of-network providers, or where an in-network provider has referred or received prior authorization for the referral to an out-of-network provider.”
Why not put this into all health plans?
“