Some incremental proposals to control healthcare costs:
1. Glass-Steagall for healthcare (Elizabeth
Warren-Josh Hawley): forbidding the
same conglomerate from owning insurer, pharmacy benefit manager, and providers.
2. Cut overpayments
to Medicare Advantage plans (stop gaming of risk adjustment, cut
benchmarks) and use the money to shore up traditional Medicare (add annual cap
on out-of-pocket costs).
3. enforce antitrust law in healthcare and impose sharp curbs on private equity
ownership/management. See former FTC Chair Lina Khan’s request for information on consolidation in healthcare markets,
an aborted revolution.
4. Expand the realm of site-neutral
payments in Medicare – that is, not paying more for a service because it’s
performed at a hospital-own facility, e.g., an outpatient center.
4. Enact proposals in the Center for American Progress’s Patient
Bill of Rights: incremental, tech-sounding reforms designed/intended to
have immediate results (see Axios
summary):
·
Take prior authorization out of insurers’ hands,
give it to independent board
·
Limit health plan rate increases/give CMS rate
review authority when states abdicate
·
Stop insurer gaming of “medical loss ratio” by limiting
profit per enrollee
·
Cap “outlier” hospital costs in excess of 300%
of Medicare in consolidated markets
·
Cap hospital price increases above trend in
consolidated markets
5. In employer coverage: sharply limit total enrollee costs
as a percentage of income. In dollar terms, that means small OOP costs for
low-income employees, potentially high costs for high-income employees.( Merrill
Goozner, former editor-in-chief of Modern Healthcare proposes this, along
with uniform rates for all payers, as is Maryland.)
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