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By gulfsouthb32553561, Feb 4 2020 04:00PM

If you’re wondering why Congress still hasn’t protected consumers from surprise medical bills, ask Rep. Lloyd Doggett, D-Texas.

“It’s troubling that it’s taking this long,” Doggett, a senior member of the powerful House Ways and Means Committee, recently told Politico.

“But this can’t be something that is 100 percent for the provider or 100 percent for the insurer. There has to be some middle ground found here.”

Congress’s failure to protect patients against a manifestly unfair practice has nothing to do with a partisan environment consumed by efforts to remove President Donald Trump from office.

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Instead, as Doggett observed, it has to do with Congress’ inability to appease rival interest groups—insurance companies and medical providers—who share blame for creating the problem.

To break the logjam, Congress should pursue a third way, one that would eliminate surprise bills by giving patients honest information before they receive care.

Patients who try to follow insurance company rules sometimes can be hit with surprise bills through no fault of their own. Insurers tell their customers that if they get care from a network doctor at a network hospital, their cost-sharing will be limited. Their insurance policies prevent network doctors and hospitals from charging them more than the rate their insurer allows. If they go out of network, they’re out of luck. That’s why most consumers seek out a network doctor to provide services at a network hospital or other facility.

What neither insurers nor hospitals tell patients is that they might also receive services from another doctor at that “network” hospital—a radiologist or anesthesiologist, for example—who is not part of their insurance company’s network.

In other words, even if someone goes to the emergency room at a hospital in their insurance network, if the doctor on duty that night happens to be out-of-network, the patient could suddenly be faced with a bill that is thousands of dollars—and not covered by their insurance.

Weeks or months later, they will get a bill for the difference between what the non-network doctor charges and what their insurance company pays, a practice known as “balance billing.”

Network doctors cannot balance bill patients. Non-network doctors can. And do. Balance bills can run into the tens of thousands, and even hundreds of thousands, of dollars.

The solution to this problem is obvious: truth-in-advertising. Congress should impose penalties on insurers that represent medical facilities—and medical facilities that represent themselves—as being in-network if doctors balance bill patients for services they provide at that facility.

Patients treated at network hospitals never should be balance billed, whether for scheduled or emergency care.

In other words, a hospital that advertises itself as being in network for insurer A, cannot allow a doctor who provides services there to balance bill a patient covered by insurer A. Ditto for insurer A. It cannot advertise a hospital as being in network if the hospital allows insurer A’s customers to be balanced billed. Neither hospitals nor insurers should be permitted to give patients false and misleading information..

Unfortunately, this is not the approach Congress is considering.

Instead, it is pursuing a flawed and unsustainable search for an elusive “middle ground” between two powerful interest groups that offer competing and faulty solutions to the surprise billing problem.

Insurers and providers agree patients should not be balance-billed. But each interest group wants the federal government to impose a regime that best serves its financial interests.

Insurance companies want the government to force non-network doctors to accept network rates. Doctors want the government to appoint arbiters to decide how much insurers should pay non-network doctors.

Both approaches involve government rate-setting, a wrong-headed idea that would invite further government intervention in the private practice of medicine.

Insurers want the government to require doctors with whom the insurer does not have a contract to accept the rates that it pays doctors with whom it does have a contract. Government should not impose contract rates on non-contracting parties.

Doctors want to outsource rate-setting to government-certified arbiters. Arbitration—including baseball arbitration, to which this approach is falsely compared—is a process in which contracting parties agree to submit disputes to an arbiter and to bind themselves to the arbiter’s ruling. The arbitration proposal on surprise billing is entirely different, because there is no contract between the doctor and the insurer.

Instead, government would bind non-contracting parties to a process to which neither has agreed, essentially franchising the rate-setting process to arbiters, who would set medical prices on an ad hoc basis.

Doctors support government-forced arbitration because they believe they will be paid more money. Insurers want government to compel non-network doctors to accept network rates because they believe they will pay doctors less.

Congress remains caught in the interest group crossfire, even as both sides continue to benefit from surprise bills at the expense of patients.

Instead of choosing between these bad ideas or, worse, finding some way to combine them, Congress should require hospitals and insurance companies to deal honestly with consumers. A hospital that grants privileges to doctors who balance bill patients cannot represent itself as a network hospital. Nor can an insurance company tell its customers that such a hospital is in-network.

That leaves the special case of emergency care at non-network hospitals—another circumstance in which patients can get hit with surprise bills. A patient with severe chest pains or one riding in the back of an ambulance can’t shop for a network hospital. Congress can protect such patients by banning non-network hospitals from balance billing for emergency care. Federal regulations currently stipulate that insurers must pay such hospitals the greatest of the Medicare rate, the network rate or the out-of-network rate.

These changes, combined with greater price transparency, will both eliminate surprise bills and empower consumers to make better decisions about their medical care.

In seeking to ban surprise bills, Congress shouldn’t takes sides between insurers and providers. Nor should it seek to split the difference between them.

Congress should take the side of consumers.

By gulfsouthb32553561, Dec 2 2019 01:38PM

Under “Medicare for All,” three quarters of Americans would be worse off financially, according to new research from The Heritage Foundation.

Here’s the bottom line: Most Americans, even many of those not making much right now, would pay more in new taxes than they would save from no longer paying for private health care.

That is the reality—but it’s not the story Medicare for All advocates are telling. Sen. Bernie Sanders promises most people will be better off with Medicare for All, and that’s why it’s worth it to make such a massive change to our health care system. The plan would abolish private coverage and force everyone onto a government-run plan.

“Are people going to pay more in taxes?” Sanders asked at a Fox News town hall in April. “Yes. But at the end of the day, the overwhelming majority of people are going to end up paying less for health care because they aren’t paying premiums, co-payments, or deductibles.”

Heritage Foundation scholars Ed Haislmaier and one of us, Jamie Hall, took a hard look at this claim, and found that the politicians are promising more than they can deliver.

In fact, it turns out Medicare for All would cost some working families more than their budget for electricity; others, their gasoline budget; and others, even more than their food budget.

As a result, 73.5% of Americans will have less money in their pockets under Medicare for All. The cost of the new taxes they have to pay will be more than what they save on health care costs.

Households that receive employer-sponsored coverage would be particularly hard hit. Their income after taxes would shrink by an average of $10,554, and 87% of them would be financially worse off.

Even lower-income working families, which currently get health care through government programs like Medicaid and the Children’s Health Insurance Program, would be worse off. Their average household income after taxes would decline by $5,592 per year.

That’s because fully paying for these programs requires taxes to go up—a lot.

Those pushing for Medicare for All have left out some essential details. No legislative sponsor of this plan has offered a way to fully pay for its promises. Instead, Sanders and Sen. Elizabeth Warren, D-Mass., have put out plans that don’t fully pay for what they’ve promised to provide, and they dramatically overestimate the revenue that new taxes on the rich could raise.

Our study uses the same means to pay for government health care as basically every other developed country uses: payroll taxes.

We ran the numbers and found that Medicare for All would require an additional tax of 21.2 cents on every dollar that every American earns. (Right now, most workers and their employers pay 15.3 cents on the dollar in payroll taxes.)

Adding that on top of other existing taxes would mean the average American would see almost half their income taken by the government.

In real life, we know that if Americans faced that kind of tax increase, some would cut back on work hours or quit working altogether. But we decided not to include that speculation in our study.

Instead, we assumed that all Americans would continue to work just as much as beforehand, while their employers convert current health insurance spending into additional taxable wages.

Under these conditions, here’s how several sample families would fare with Medicare for All.

Olivia Williams: an unmarried mother of two earning $31,000 a year. She would be worse off by $1,547.

Under Medicare for All, Olivia would lose almost exactly the amount she spends on electricity every year.

Today, she gets her health coverage through her job, and her children get their coverage through the Child Health Insurance Program. Under Medicare for All, her current health costs go away—but she’ll still lose $1,547, or 5.3%, of her disposable income.

The Suarezes: a median-income married couple earning about $98,000, with two kids and employer health benefits. They would be worse off by $9,201.

Today, the Suarezes get their health coverage from dad’s employer. Under Medicare for All, their health costs go away, but they’d still lose $9,021, or 13.3%, of their disposable income—about as much as they spend on food today.

The Joneses: a lower-middle-income married couple earning nearly $50,000, with two kids and employer health benefits. They would be $1,619 worse off.

Today, the Joneses get health coverage through mom’s job. Under Medicare for All, their health costs would go away, but they would still lose $1,619, or 4.4%, in disposable income. That’s about as much as they spend today on gasoline.

John Johnson: a median-income unmarried man without dependents. He would be $3,542 worse off.

Today, John earns about $41,000 and gets health coverage through his job. Under Medicare for All, his health costs would go away, but he’ll still lose $3,542, or 13%, of his disposable income. That’s about as much as he spends today on car insurance and maintenance.

Less Money for Most People

Medicare for All would make most Americans worse off financially, not better.

What’s more, Americans would be getting a lower quality product, based on what we’ve seen in other countries with government-run health care. For example, wait times to receive care in Canada are longer than those in the U.S., and in Britain, morale among doctors is often low, since they face bureaucratic hurdles and larger workloads.

However, the status quo in America is not the solution, either. Costs here are too high and choices are too few—and too many Americans feel that special interests and big government benefit from the current system, rather than them.

Congress should work toward real solutions that address these concerns at their root causes. But Medicare for All won’t accomplish that, no matter what its advocates say. It needs to come off the table.

By gulfsouthb32553561, Dec 2 2019 01:36PM

Imagine strapping your infant child into a car seat, only to see his body suddenly jerk forward or backward, arms and legs stiffening, and eyes rolling back in the head.

Alarm quickly turns to panic, which turns to frantic weaving through traffic to get to the hospital. Within minutes of arriving, the child is rushed in for treatment with a team of neurologists by the bedside carefully taking notes.

That child was me.

My parents sat in shock, with tears streaming down their faces as my fate was unknown. I was quickly whisked to the CT scanner, and later that night a neurologist told my mother, her tearful eyes full of sorrow and hurt, “Your child has West syndrome, a severe form of epilepsy.”

She continued, “We have very few options for treatment, and the ones we can try may not work. There is over a 90% chance he will never be able to speak, walk, eat, or think. His impairment will be indefinite.”

Because time was of the essence, I was treated almost immediately with Adrenocorticotropic hormone (ACTH). This wasn’t a new drug and was not considered a “cure.” I had to have constant supervision, at least a weekly check, from a neurologist while on the drug.

Remarkably, I found myself in the top 1 percentile of people with West syndrome who could enjoy a mostly normal life. Thanks to the top-notch medical treatment I’ve receive in America, I can do most of the things the neurologist predicted I wouldn’t be able to.

It wasn’t until after college that I realized just how uniquely American my story is.

Life Under Socialized Medicine

After graduating college, I had an opportunity to work for a think tank in London. There, I’d be just hours away from the wonders of mainland Europe.

Britain is a historian’s paradise, so naturally as a history major, I was soaking it up. The idea of also going to Pompeii or Rome was spectacular.

The only thing standing in my way was a doctor to treat me abroad.

As an epileptic, I needed a steady supply of anti-seizure drugs and visits to the doctor about every three months to make sure everything was working as it should. I also needed a doctor to be available within a week’s time if necessary.

I didn’t know how hard it would be to find a doctor in Britain. I remember having a very difficult conversation with a general practitioner. It was the moment my dream of staying abroad was crushed.

It was a Friday. After work, I walked into an urgent care clinic to set up an appointment with a neurologist.

I knew how easy it is in the United States to see a doctor, so I thought this would be no different. I would go in, get a recommendation, and walk out with a name and number to call on Monday for an appointment possibly in two weeks’ time.

Sadly, that was not the case. The doctor said, verbatim: “I can recommend a neurologist for you. I will say, she’s pretty booked so you won’t see her for at least nine months.”

I was shocked. I felt as if I’d been blindsided. She wasn’t even guessing. She worked at a nearby National Health Service hospital right down the street on the weekends, so she knew.

I asked if there was anything I could do to expedite the waiting process. In response, all I got was: “I’ll call my colleague and see if she could maybe squeeze you in maybe three to four months from now.”

Disheartened by the news, I knew staying in the U.K. was out of the question. I had to return to the U.S. in order to keep accessing the routine medical care that had saved my life so many years before.

A month later, I packed my bags and left for Heathrow Airport having spent less than three months in the country. It’s a shame, because Britain is an amazing country and I would have loved to stay longer. Health care should not be a reason to have to leave a modern, First World country.

I am writing this not just to relate a sad story, or to say how lucky I am, or to shock my readers. I write this so that everyone who reads it will understand what’s at stake in our health care debates, and what good, responsive health care is for someone who relies on it to live a fruitful life.

I cannot go a day without taking medicine or without knowing if I’ll be able to see my doctor in a timely manner. My life is only made possible by the high-quality care and access I get in the United States. It’s something other countries don’t enjoy.

Yet today, some Americans want U.S. health care to move in the direction of Britain and Europe. Prominent House and Senate Democrats are pushing “Medicare for All” legislation that would outlaw private insurance, cost Americans trillions of dollars, and put countless American patients on waiting lists like the one I faced.

The outcome of this ongoing debate will impact Americans for generations to come. We can’t afford to decide our future based on wishful thinking. Americans need to know what socialized health care is like.

In England and Canada, it is standard for patients to wait twice as long as in the U.S. to see a specialist, according to the National Community Pharmacists Association. In fact, nearly 1.8 million people are currently waiting for a hospital admission or outpatient treatment in the U.K.

People from all around the world come here every year to receive medical care they can’t access in their home countries. We should consider what we have that they don’t, and make sure we protect it.

I’ve experienced firsthand what it’s like to live in a country that can meet my health care needs, and to live in one that can’t. Given the choice, I’d pick the U.S. system every single time. My life depends on it.

By gulfsouthb32553561, Aug 5 2019 02:24PM

President Donald Trump says he wants health reform that will be better than Obamacare, better than what we had before Obamacare, and better than the Democrats’ “Medicare for All.” And he’s not alone.

Numerous surveys show that health reform remains a top priority for Americans, who are concerned about high costs, access, and choice.

To address these problems, health reforms should focus on making it as easy as possible for people to access innovations such as:

Personal, “portable” health insurance that travels with them from job to job and in and out of the labor market.

Round-the-clock communication with their personal physicians by phone, email, and Skype.

Telemedicine, so they can even “visit” the doctor from home—avoiding traffic, long waits, and unneeded emergency room visits.

Centers of excellence that specialize in chronic health conditions (including preexisting conditions) and actively compete for patients.

Accounts owned and controlled by patients who are willing to manage their own care, including most forms of chronic care and even routine surgery.

Government should not mandate these changes. If employees and their employers like the arrangements they now have, they should be able to keep them.

But government needs to get out of the way, cut red tape and conflicting requirements, and quit interfering with the opportunity for people to have better options.

The Trump administration has already implemented executive actions that have brought us closer to all five of these goals. But to complete the reforms, Congress needs to enact legislation.

Here are some particulars.

1. Personal and portable health insurance.

In an ideal world, most people would own their own health insurance and take it with them as they traveled from job to job and in and out of the labor market.

Some employers may have better insurance than is available on the open market. But others might prefer to make a cash contribution to help employees pay their own premiums rather than provide insurance directly.

Some employers were actually doing that before Obamacare. They used an account called a health reimbursement arrangement, providing tax-free funds employees could use to buy their own health insurance.

But with Obamacare came regulations and threats of steep employer fines that effectively deep-sixed this option.

Thankfully, the Trump administration is reversing course. Beginning next January, employers will be able to use health reimbursement arrangements to help employees obtain their own coverage with the administration’s blessing.

The Council of Economic Advisers estimates this change will affect 11 million workers. But it would affect far more if states cleaned up their individual markets to make them a more attractive option.

Congressional action should codify what the administration has already done and expand the reform in several ways.

In particular, states need broad authority to authorize insurance products that meet their residents’ needs, rather than meeting Obamacare’s expensive mandates.

Congress also needs to give states the freedom to make reforms that would lower costs and expand access to care.

2. Round-the-clock medical care.

Concierge doctors used to be available only to the rich. Today, “direct primary care” is far more affordable.

Atlas MD in Wichita, for example, provides all primary care along with 24/7 phone and email access and generic drugs for less than what Medicaid pays. It helps patients gain access to specialist care and diagnostic tests, with minimal waiting.

The cost: $50 a month for a middle-aged adult and $10 a month for a child.

There are 790 direct primary care practices like Atlas in the United States. Typically, they provide round-the-clock access to a physician via phone, email, and Skype.

These practices have a number of attractive features—and an excellent track record: They expand access to care, improve the quality of care, reduce overall health care spending, and report high levels of patient satisfaction.

This development has the potential to radically transform the way medicine is practiced in the United States. The only things standing in the way are unwise public policies.

A number of employers are creating access to direct primary care as an employee benefit. However, under current law they cannot put tax-free dollars into an account and let employees use the money to select a direct-pay doctor of their choosing.

The Trump administration has directed federal agencies to see if health reimbursement arrangement accounts and health savings accounts (see below) can be used as vehicles to overcome the current regulatory obstacles.

In addition, the administration hopes to make Medicare more open to direct primary care.

Under the arrangement, Medicare would pay a fixed monthly fee to a physician or physician group instead of the traditional fee-for-service payments. In return, the physicians would provide virtually all primary care.

The fees would range from $90 to $120 a month, depending on the patient’s age and medical complexity.

While this is a good start, more is needed to make direct primary care widely available to Medicare patients. The reason: Most direct primary care doctors have opted out of all third-party insurance arrangements, including Medicare.

These doctors cannot contract with a Medicare patient unless they are in Medicare. Further, once in Medicare, doctors won’t be free to engage in the type of innovation that makes direct contracting so successful.

Congress can and should eliminate this catch-22.

3. Access to telemedicine.

The ability to deliver medical care remotely is growing by leaps and bounds. It promises to lower medical costs, increase quality, and reduce the time and travel cost of patient care.

For example:

After hip and knee replacements at Tallahassee Memorial HealthCare, patients are transported to rehab facilities, nursing homes, and even their own homes—where follow-up observations are made with video cameras.

A nurse at Mercy Virtual Hospital in St. Louis can use a camera in a hospital room in North Carolina to see that an IV bag is almost empty. She can then call and instruct a nurse on the floor to refill it. The telemedicine cameras are powerful enough to detect a patient’s skin color. Microphones can pick up patient coughs, gasps, and groans.

The problem? Medicare doesn’t pay for any of this. And since private insurers and employers tend to pay the way Medicare pays, the entire country is missing out on incredible advances in telemedical technology.

This is not an accident. Federal law (the Social Security Act) allows Medicare to pay for telemedicine only under strictly limited circumstances. For the most part, doctors can examine, consult with, and treat patients remotely only in rural areas, and even there, patients can’t be treated in their own homes.

The Centers for Medicare and Medicaid Services is acting aggressively to change this.

As of Jan. 1 of this year, doctors in Medicare Advantage plans and accountable care organizations can now bill Medicare if they use phone, email, Skype, and other technologies to consult with patients remotely to determine if they need an in-office visit. Patients can be anywhere, including their own homes.

Doctors can also bill Medicare to review and analyze medical images patients send them. And they can bill for telemedical consultations with other doctors.

But these are still baby steps. Congress needs to liberate telemedicine once and for all.

4. Access to centers of excellence.

On the Obamacare exchanges, there has been a race to the bottom as health plans try to attract the healthy and avoid the sick. Increasingly, enrollees have been denied access to the best doctors and the best facilities.

In Dallas, Texas, for example, no individual insurance plan includes Southwestern Medical Center, which may be the best medical research center in the world.

In Texas generally, cancer patients with Obamacare insurance don’t have access to MD Anderson Cancer Center in Houston. This pattern is repeated all over the country.

The most successful Obamacare insurers are Medicaid contractors. The plans that have survived in the exchanges look like Medicaid managed care with a high deductible. The networks include only those doctors who will accept Medicaid fees coupled with all the hassle of managed-care bureaucracy.

Before Obamacare, most states had risk pools for the small number of people who entered the individual market with an expensive preexisting condition and were denied access to ordinary insurance coverage.

The risk pool plans looked like garden-variety Blue Cross plans, with access to almost all doctors and hospitals. While some risk pools had problems—such as being over-subscribed and unable to take new customers—those problems were discrete and addressable.

Obamacare threw out this model in favor of a D.C.-designed solution. The result? Access to care for people with preexisting chronic conditions has seriously deteriorated. That needs to change.

Entities such as Cancer Treatment Centers of America need to be able to enter the individual market, restrict enrollment to patients who have cancer, and receive a premium that covers their expected costs.

Instead of expecting every health plan to be all things to all patients, we should encourage specialization. We need focused facilities for such chronic conditions as cancer care, diabetic care, and heart disease.

To make the market work better, medical records need to travel with the patient from plan to plan, and insurers need to be able to design better risk-adjustment mechanisms rather than being forced into federal government-designed systems.

How can these changes be made? Here, it is even more critical that government clear away today’s barriers and let private markets function.

Some of this is already being done by executive rule-making and through waivers. The president has taken aggressive steps in this direction, giving states new authority to experiment.

This has already led to lower costs in seven states. In Maryland, premiums that had been expected to rise 30% actually fell by 13% thanks to state reforms.

Congressional action will almost certainly be needed to complete the task. Ideally, states should be given broad authority to reform their private individual markets, with one important proviso: Conditions must get better for people who have health problems.

“Better” means lower premiums, lower deductibles, and broader networks of providers. And people who are sick or in low-income households must be free to use their existing subsidies to pick the right plan for them, rather than being warehoused into Medicaid or Obamacare.

States must not only show unmistakable progress in this respect, but also establish as a goal a market in which sick people can get access to the doctors they need—without raising costs for everyone else, as Obamacare does today.

It doesn’t take new federal mandates and programs to reach these goals. Rather, the Trump administration’s regulatory relief has amply demonstrated that we move in the right direction when states are allowed to escape existing mandates that have distorted market incentives and led to our current problems.

Congress could help empower the states to carry out needed reforms by enacting the Health Care Choices Proposal, developed by the Health Policy Consensus Group and supported by more than 100 conservative leaders across the country.

This proposal would block-grant Obamacare funds to the states and give them wide discretion to reform their individual health insurance markets.

The Center for Health and the Economy estimates that this proposal would lower health care premiums by as much as a third, would insure about the same number of people as Obamacare, and would better protect people with preexisting conditions and high health costs.

5. Patient power.

How can we control health care costs and at the same time improve quality and create greater access to care? Here is one answer: Give patients control over more of their health care dollars.

Roughly 25 million people now manage some of their own health care dollars through health savings accounts, which they own and control.

The evidence shows that these patients are conservative shoppers in the medical marketplace—saving money without any deterioration in the quality or access to care. However, the potential for these accounts is much greater.

Right now, patients use health savings accounts primarily to pay small medical bills below their deductibles. But these accounts could and should be used in just about every aspect of medicine, including expensive surgery, chronic illness, custodial care, and emergency-room visits.

For example, there is mounting evidence that patients suffering from diabetes, heart disease, cancer, and other chronic illnesses can (with training) manage a lot of their own care as well as—or better than—traditional doctor therapy can.

If they are going to manage their own care, they will do an even better job if they are also managing the money that pays for that care.

In addition, there is no reason why patients could not manage almost all the money used for primary care, including routine doctor visits and most diagnostic tests—spending from a health savings account that they own and control.

If patients control the money, it will flow toward cost-saving options. They will substitute less expensive phone and email consultations for doctor’s-office visits; they will shop for better prices on everything from blood tests to mammograms; and they will opt for walk-in clinics and free-standing emergency care instead of hospital emergency rooms when appropriate.

On the East Coast and the West Coast, Uber-type doctor visits at nights and on the weekends are an increasingly popular alternative to the emergency room. A doctor house call costs about $100, and the doctor usually arrives within an hour. Emergency rooms typically charge about five times more.

Give patients control of the money and you will see this service all over the country.

Health savings accounts can also help control the cost of expensive surgery.

For example, WellPoint (Anthem) in California limited the amount it would pay for hip and knee replacements to $30,000 for its CALPER enrollees. Patients could get the procedure done at any hospital, but if the cost was greater than that amount, they had to pay out of their own pockets.

This experiment had a dramatic effect, bringing down the cost of surgery across all of California.

But the impact would have been even more dramatic if WellPoint had deposited $30,000 in the account of every patient who was a candidate for surgery. That way, if a patient found a hospital whose cost was, say, $28,000, the patient would enjoy a $2,000 “profit.”

Both insurers and their enrollees would do better still if they considered traveling for care.

Health City Cayman Islands offers high-quality hip and knee replacements for one-half to one-third less than what the procedures cost in California. Employers have found employees not very receptive to medical travel.

But let the patient have $30,000 in a health savings account with the opportunity to save $10,000 or more, and the willingness to travel is likely to soar.

To take advantage of the full potential of health savings accounts, we need three policy changes:

People should be able to use completely flexible health savings accounts, wrapping them around any health insurance plan and using them to pay for any medical costs the plan does cover.

They should be able to use their health savings accounts to pay premiums as well as out-of-pocket expenses.

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 health savings account.

The Trump administration recently made a major announcement with respect to the first of these changes. Going forward, employees with health savings accounts 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 health savings account regulations.


The reform agenda proposed here would radically transform the U.S. health care system by empowering patients, liberating markets, and removing government obstacles to lower-cost, higher-quality, more accessible health care.

It builds on emerging successes by innovators empowered by the president: doctors trying new ways of delivering care, states trying new ways of healing broken private markets, and patients demanding better care at lower costs.

The president should build on these successes and work with Congress to clear away the barriers blocking these innovators from spreading their wings. That’s the way to provide better care at lower costs.

By gulfsouthb32553561, Aug 5 2019 02:21PM

Fine, but you should know exactly what you’re giving up in the bargain.

These “debates” are to serious policy discussions as a kazoo is to an orchestra. You can say a kazoo is an instrument, and you can say that these truncated thoughts are proposals, but you’ll invite smirks.

This is not a slam on Democrats. The Republican “debates” in 2016 were no better. When a stage is sardined with candidates, there is no alternative to keeping answers short. If the voters had longer attention spans, we could arrange four or five nights of less manic encounters, which would give candidates the chance to explain themselves. But since we don’t, we have unedifying and demeaning soundbite-ping-pong matches.

It isn’t clear that they merit the intense media interest they generate. Must Biden prove he’s not too old? Must Cory Booker “have a moment” after a lackluster first debate? Maybe. Then again, Donald Trump performed abysmally in the 2016 debates. He didn’t know the issues and made excruciating errors. His great skill, if you can call it that, was in lobbing juvenile taunts at his rivals. Yet he was acclaimed the winner by the viewers.

Several candidates this week stressed that the Democratic party is veering too far to the left, which was refreshing, if probably futile. The undertow pulling the party left is very strong. As recently as 2009, the public option in health care was considered too extreme, which is why President Obama omitted it. Now, it’s the moderate position compared with Medicare for All, which is endorsed by Bernie Sanders, Elizabeth Warren, Andrew Yang, Bill De Blasio, Julián Castro, and, with some reservations, Kamala Harris and Pete Buttigieg.

As usual, Bernie Sanders and Elizabeth Warren were in full outrage mode about the corporate villains who are sucking us dry. It isn’t a sign of our political maturity that the most successful politicians now are demagogues who find some target to blame — foreign competition, immigrants, greedy corporations, millionaires, and billionaires. Warren claims that “giant corporations” and billionaires will foot the bill for her MFA, which rivals Trump’s claim that Mexico would pay for his wall. Sanders pointed to the nation across the river from Detroit to shame Americans about health care’s not being treated as a “yooman right” in this country.

This seems like a good time to review what Canada’s single-payer health-care system does and doesn’t do.

It’s true that all Canadian citizens and legal residents (though not illegal immigrants) get “free” health care, but only in the sense that you don’t get a bill after seeing a doctor or visiting a hospital. Medical care is subsidized by taxes, but the price comes in another form as well — rationing. A 2018 report from the Fraser Institute, a Canadian think tank, found that wait times between seeing a general practitioner and a specialist average 19.8 weeks. That’s the average. There are variations among specialties. Those waiting to see an orthopedist wait an average of 39 weeks, while those seeking an oncologist wait about 3.8 weeks.

Canada has the same modern medical technology that the U.S. offers, but Canadians must wait more than a month for a CT scan, more than ten weeks for an MRI, and almost a month for an ultrasound.

Imagine the anxiety of learning that you need an MRI to find out whether the mass in your breast is anything to worry about and then being told that the next available appointment is in ten weeks. In addition to the psychic price, Canadians who had to wait for treatment expended an average of $1,972.00 out of pocket last year, owing to lost wages and other costs. The Fraser Institute also calculated the value of the lost productivity of those waiting for treatment — nearly $5,600 per patient, totaling $5.8 billion nationally. Wait times to see physicians in the U.S. have been creeping up in recent years — perhaps in response to increased demand following Obamacare — but remain much shorter than those in Canada or other OECD countries with nationalized health services.

When there’s an artificial shortage of a good or service, a black market usually follows. I have heard from several Canadians that paying doctors bribes to jump the line is not uncommon. But Canada has another pressure reliever: 90 percent of Canadians live within 90 miles of the U.S. border, and medical centers in Buffalo, Chicago, Rochester, and elsewhere receive tens of thousands of Canadian patients every year.

Advocates respond that Canadians are happy with their system, and that’s fine. It’s their choice. But Americans tend not to be so docile about delays. And in any case, the Democrats’ pretense that we can provide Medicare for All and receive the same level of care we’ve become accustomed to is applesauce. You want the Canadian system? Fine. Just know what you’re giving up.

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