If Trump wins, Republicans may pursue a major reform that would officially enshrine a two-tier health care system in America. Here's my review of a book that outlines one possible plan.
Medicare-Lite is a dangerous agenda for several reasons:
- people can easily be duped into believing that it will include “essential services” (similar to how people are being tricked into signing up for MA plans)
- it gives nefarious politicians cover to privatize Medicare that provides insurance to senior citizens (which is already happening with MA plans)
- reinstate “pre-existing conditions” in the secondary insurance market, allowing insurance companies to make massive profits
- continue and escalate the rhetoric to blame doctors for not taking care of people and for bad outcomes
- gut other social safety nets to pay for Medicare-Lite, worsening overall healthcare of the population (see my article on “Doctors as Social Workers” at www.PCPLens.com )
Price controls, especially for drugs, are critically important. JAMA published an article showing that the cost to develop new drugs is approximately three times lower than pharmaceutical companies claim (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820562).
I am not an actuary, but separating high-risk and low-risk pools increases prices for everyone, as everyone will eventually get sick and fall into the high-risk pool.
Wow, this was a great review of the state of things! One of the things that I see regularly is wealthy patients looking to buy better care. But the lesson from many years of health economics is for them to get better outcomes their providers need more volume of experience. By covering everyone, care and outcomes improve beyond what is possible for any one individual regardless of means. In my own experience a baby today born at 29 weeks almost always survives without long term complications. 50-60 years ago, virtually none survived and the rare few that did has lifelong disabilities. Now, because we treat them all and have developed volume specialized centers, the average care is far better than the best possible care of yore. Helping the wealthy who fear they might bear the brunt of the cost understand that they also will receive much of the benefit is key to expanding coverage.
Medicare-Lite is a dangerous agenda for several reasons:
- people can easily be duped into believing that it will include “essential services” (similar to how people are being tricked into signing up for MA plans)
- it gives nefarious politicians cover to privatize Medicare that provides insurance to senior citizens (which is already happening with MA plans)
- reinstate “pre-existing conditions” in the secondary insurance market, allowing insurance companies to make massive profits
- continue and escalate the rhetoric to blame doctors for not taking care of people and for bad outcomes
- gut other social safety nets to pay for Medicare-Lite, worsening overall healthcare of the population (see my article on “Doctors as Social Workers” at www.PCPLens.com )
Price controls, especially for drugs, are critically important. JAMA published an article showing that the cost to develop new drugs is approximately three times lower than pharmaceutical companies claim (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820562).
I am not an actuary, but separating high-risk and low-risk pools increases prices for everyone, as everyone will eventually get sick and fall into the high-risk pool.
Wow, this was a great review of the state of things! One of the things that I see regularly is wealthy patients looking to buy better care. But the lesson from many years of health economics is for them to get better outcomes their providers need more volume of experience. By covering everyone, care and outcomes improve beyond what is possible for any one individual regardless of means. In my own experience a baby today born at 29 weeks almost always survives without long term complications. 50-60 years ago, virtually none survived and the rare few that did has lifelong disabilities. Now, because we treat them all and have developed volume specialized centers, the average care is far better than the best possible care of yore. Helping the wealthy who fear they might bear the brunt of the cost understand that they also will receive much of the benefit is key to expanding coverage.
Evidence shows that high volume providers of specialized care do better than the occasional practitioner.