Three Paths Toward Improving our Health Care System

Medicaid is a joint federal and state program that gives health coverage to Americans with limited income.

We are living through the greatest health care crisis to face a rich world nation in the post-World War II era. Americans are spending over four times as much per capita on health care today than we were in 1980. Health care spending in the United States has increased from $74.1 billion in 1970 to $4.1 trillion in 2020.

Consumers need to be able to afford the industry’s offerings for a health care system to properly support the society within which it functions. According to a 2018 study by Harvard University and London School of Economics researchers, pharmaceutical spending per capita was $1,443 in the U.S. compared to a range of $466 to $939 in other nations.

The study also confirmed “that the U.S. has substantially higher spending, worse health outcomes, and worse access to care than other wealthy countries.” The system is not working for everyday Americans. We are in urgent need of intentional, meaningful reform.

Consumers need to be able to afford the industry’s offerings for a health care system to properly support the society within which it functions.

21^st century proposals

Since this century began, popular health care reform proposals have focused on some combination of increasing access, maintaining or improving a high level of quality, and, of course, reducing costs for patients. These focus areas ring true across the aisle: from proposals put forth at different points by President George W. Bush to President Barack Obama to GOP House Speaker Paul Ryan to Independent Senator Bernie Sanders.

President Bush’s administration recommended expanding health savings accounts and providing tax credits to individuals who purchased insurance. Critics contended it did not focus enough on reducing the number of uninsured individuals.

President Obama’s administration passed the Affordable Care Act (ACA), also known as Obamacare. It increased access to health care by allowing the expansion of Medicaid and providing subsidies for individuals who purchase insurance on private individual marketplaces. This reform focused primarily on increasing access and, to a more limited degree, on reducing costs. Some members of Congress criticized it for the increased government role in health care.

Speaker Ryan and the GOP proposed a replacement for the Affordable Care Act with a system of vouchers and tax credits. His proposal faced stiff opposition from both parties over questions of his timeline for passage and a lack of focus on low-income consumers.

Senator Sanders’ Medicare for All plan, which is the most recent reform proposal, would create a single-payer health care system. Criticisms of this plan center around funding and federal spending questions.

As we consider future proposals, we should concentrate on the aspects of past reform initiatives that targeted cost reduction for patients and their families. The Bush administration and Ryan proposals aimed to reduce costs by encouraging competition in the health care industry. The ACA attempted to reduce costs by implementing cost-saving measures such as requiring non-profit hospitals to offer “charity care” programs. Sanders’ plan aims to reduce costs to Americans by eliminating private sector insurance companies and their administrative costs.

Increasing price transparency, encouraging freer competition in the health care market, and increasing the supply of medical professionals all have the potential to bring down costs.

Greater transparency would help reduce costs

Yes, we should reduce administrative costs, but there is a plethora of effective solutions to address the skyrocketing costs being paid by Americans. Increasing price transparency, encouraging freer competition in the health care market, and increasing the supply of medical professionals all have the potential to bring down costs.

A lack of transparency is a critical shortfall of today’s health care industry. For example, the ACA created “charity care,” but the nonprofit hospitals legally bound to offer the service are not required to disclose this fact to their customers. Instead, nonprofit organizations like Dollar For advocate on behalf of these consumers and have helped relieve tens of millions in medical debt.

We can achieve greater price transparency by requiring hospitals and other providers to disclose the prices they charge for procedures and services. The Centers for Medicare and Medicaid Services (CMS) has been promoting price transparency in health care through its Hospital Compare website and the Hospital Price Transparency guidelines.

A much-needed increase in price transparency would allow consumers to make more informed decisions about their health care. This development would encourage healthier markets in which providers could compete.

Creating a system for comparing prices across providers can also help increase price transparency. CMS’s Hospital Compare website and the Hospital Price Transparency Final Rule allow patients to compare the cost of care across different hospitals. Also, private websites, such as Healthcare Bluebook, allow patients to compare prices for specific procedures across different providers.

Patients should be provided with information about the cost and quality of providers, allowing them to make informed choices. The CMS’s Hospital Compare website and the Hospital Price Transparency guidelines provide data on the quality of care provided by hospitals. Private websites, such as Healthgrades, allow patients to compare the quality of care provided by different providers.

Encourage market competitiveness

A much-needed increase in price transparency would allow consumers to make more informed decisions about their health care. This development would encourage healthier markets in which providers could compete.

Making the marketplace more competitive would benefit consumers by reducing duplicative efforts, redundancies, and overall inefficiency. Allowing patients to choose from a variety of providers, both within and outside of the traditional health care system, can increase competition and drive down costs.

Encouraging the development of new, more efficient health care delivery models can also help increase competition and reduce costs. Examples include telemedicine, retail clinics, and accountable care organizations (ACOs).

Furthermore, policies should be in place to prevent anti-competitive behavior, such as price-fixing and collusion among providers, which drive up costs. Numerous studies have shown that hospital mergers have been a powerful driver of increased prices in various metro areas. According to the NIHCM Foundation, “there is very little evidence that consolidation improves quality of clinical care, and some evidence that quality is worse in less competitive markets or after a hospital acquisition.”

The Federal Trade Commission and the Department of Justice enforce federal antitrust laws that prohibit anti-competitive behavior in the health care industry. This proposed deregulation of the market would certainly reduce inefficiency and open doors for an increased supply of medical professionals.

Broadening the medical professional pipeline and increasing supply, while maintaining modern competency and ethics standards, is another crucial step in reducing health care costs. According to the Association of American Medical Colleges, America is facing a shortage of as much as 121,900 physicians by 2032.

By increasing funding for medical education and training programs, we can move toward meeting the demand for health care. In addition, initiatives such as the Latina STEM fellowship launched by the TCU Burnett School of Medicine’s Diversity and Inclusion office in collaboration with Tarrant Community College, if more widely implemented, would certainly broaden the pipeline. Improvements in working conditions for medical professionals would also augment the likelihood of a greater supply as a result of broader appeal in the market.

The United States clearly is facing a health care crisis that deserves our attention. The burdensome cost of health care troubles both individual consumers and the economy as a whole. Bringing down costs would allow more Americans to afford the care they need, reduce the stringent financial burden on businesses, and foster economic growth.

The strategic approach pathways mentioned above are effective means to reduce costs. These reforms are well past due. It is time for America to settle its debt with its people.