Marc Siegel COMPROMISE ON HEALTH CARE PLAN
Six ways Republicans should work with Democrats to help patients and doctors
Back in 1997, House Speaker Newt Gingrich reached across the political aisle to create a bipartisan coalition with President Clinton to address the budget and Medicare and Social Security reform. These efforts made a big and positive impression on the public psyche.
By contrast, the recent battles over health insurance reform have lacked any kind of consensus-building. Obamacare was forced through with only Democratic votes, and now the GOP “repeal and replace” drive is following the same party-line path.
On an issue as complex and central to our lives as health insurance, there should be bipartisan compromise. Here’s how:
First, Republicans should offer to keep the popular Medicaid expansion, especially because 20 GOP senators represent the 31 states that have it. True, Medicaid is filled with waste and cumbersome paperwork. But rather than cut it, a better solution is to connect a basic scaled-down product with a built-in bridge to jobs programs and premium support for increased services.
Second, remove the section that defunds Planned Parenthood. This would attract Democratic votes. Defunding Planned Parenthood may be part of the GOP platform, but it has nothing to do with the health care law and should be addressed separately if at all.
Third, a consensus over high-risk pools and catastrophic options could pave a path to true bipartisanship. Both sides are aware that comprehensive one-size-fits-all insurance has led to soaring premiums and deductibles and insurers dropping out. But the Democrats are concerned that separating out sicker, higherrisk patients could lead to soaring premiums they can’t afford. Under the proposed new law, a state requesting a waiver can use highrisk pools only for those whose coverage has lapsed. But the Kaiser Family Foundation has reported that these pools have always been underfunded. For patients with lapsing coverage, Republicans must offer sufficient subsidies to bring the premiums in the pools down to an affordable range.
Fourth, Democrats can show they are willing to compromise by agreeing to catastrophic options and a la carte insurance choices in states that take waivers to shrink essential benefits (for those with lapses in coverage). We are a compassionate society, and we need to make sure that everyone has access to basic labs and prescription drugs, maternity, and mental health and cancer prevention screening. But why put the entire burden for payment across the whole society when a small percentage use most of the care? It would be more efficient and less costly if the government picked up the tab directly for those who couldn’t otherwise afford it. No owner of an old Toyota wants to be compelled to buy the same elaborate collision insurance as the owner of a new Ferrari.
Fifth, there is agreement that we need a health care safety net for all, but there is disagreement on the best way to achieve it. Some Democrats advocate for a single-payer system or Medicare for all, but the insurance industry is too entrenched and powerful in this country for this to ever happen. Obamacare has reduced the number of the uninsured by 20 million, including the Medicaid expansion, but hasn’t done enough to improve access to inexpensive effective health care. The Congressional Budget Office now predicts that 23 million people will lose their insurance by 2026 if the House Republican proposal is passed and the mandates removed. But the number would be less than half of that if the Medicaid expansion were kept and user-friendly catastrophic options added. There is also another safety net for the uninsured. The National Health Service Corps of physicians serves 11 million people, and federally funded clinics provide care for 22 million, mostly in rural areas. These need to be expanded to inner cities.
Finally, recognize that we doctors are drowning in electronic record-keeping, defensive medicine bred of fear of liability, and excess time spent fighting with insurers for approvals and payments on behalf of our patients and ourselves. To relieve our burden we need tort reform; universal insurance forms, approvals and procedures; and more price transparency and payment up front through health savings accounts. We need more medical school graduates and more nurse practitioners.
Any new bipartisan health care law should consider the struggles of doctors and patients alike.
Marc Siegel, a member of USA TODAY’s Board of Contributors and a Fox News medical correspondent, is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center.