Health Care for All


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Our Sick Health Care System

Health care in America is sick, and we must heal it to improve the lives and “promote the general welfare” of our people, as the United States Constitution promises. Americans pay more than anyone in the world for a system that delivers some of the worst care at the highest costs. This kind of outcome differential doesn’t add up.

Moving from “Sick Care” to “Health Care”

As stated in the United States Constitution, a fundamental goal of our country is to “promote the general welfare” of our people. As such, it is time to invest in “health care” rather than continually propping up a “sick-care” system that has left America paying more than anyone else in the world with outcomes that don’t exactly match our costs.

My Health Insurance Experience

As a veteran who proudly served my country, I have been grateful for the ability to receive coverage under Tricare. While Tricare is an example of a program our country established to meet its social contract with those who served in the military, our country’s social contract to ensure its citizens are healthy should not end with military members and veterans or the aged, disabled, or poor—it should extend to every single American.

Moral and Financial Consequences of our Current System

Unfortunately, many others do not have the same security that Tricare has afforded me. There are countless examples of Texans whose health and economic well being has suffered at the hands of our health care system.

Interim Solutions Along the Path to Universal Health Care

This country’s health care system is failing tens of millions of Americans. The status quo we have costs too much, results in poor outcomes, and results in millions of Americans who go without access to health care, many of whom suffer and needlessly die after they wind up in the emergency room, where we collectively pay for the worst outcomes at the highest cost.

Medicaid Expansion and Buy-In

Medicaid expansion is the provision of the ACA that allows states to expand Medicaid coverage to anyone under 65 who earns 138% or less of the federal poverty level. (For 2017, that is about $34,900 per year for a family of four.)

Public Option

As discussed in the debate leading up to the passage of the ACA, a public option is a pathway that Congress should consider to create a health insurance plan that can compete with those offered by private insurers on the Marketplace. While that option was dismissed for political reasons, bringing in a competitive plan to ensure that private insurance companies do not overcharge consumers is one way to address existing issues within the Marketplace related to cost.

All-Payer Rate Setting

Congress should also reform facility and provider payments from the vastly unregulated and unfair field it is today to one that allows facilities and providers to be paid fairly, but not at the expense of consumers who have one insurance company versus another.

Prescription Drug Prices

Drug makers have spent more than $2.3 billion lobbying Congress over the last decade – more than any other industry, which explains why no legislative proposal to rein in rising prescription prices has gone anywhere.

Patent Litigation Reform

Large pharmaceutical companies routinely abuse the patent system, continually tweaking old formulas superficially to abusively extend monopoly rights so that consumers pay increasingly high amounts for their necessary prescriptions.

Ban Gag Clauses/Pharmacy Benefit Manager Clawbacks

Gag clauses are commonly used by pharmacy benefit manager (PBM) companies to ensure consumers pay unnecessarily high prices for prescription drugs. These clauses ban pharmacists from telling consumers that they could save money by paying out of pocket for prescriptions, under the threat that the pharmacy will be kicked out of the insurer’s network if they fail to comply. This is simply immoral, and Congress should act immediately to prohibit these agreements. Some state legislatures, including Texas, have recently done so.

Research Investment Return Reform

American taxpayers invest billions annually underwriting the development and distribution of prescription drugs and insulating private drug companies from direct competition. However, once we write the check to these companies to support this research, the American health care consumer is sometimes abused through exorbitant and unethical price gouging for the drugs their tax dollars went to develop. Currently, there is inadequate regulation on the pharmaceutical industry to ensure drug companies won’t charge grossly excessive amounts to Americans, including vastly more than these companies charge consumers in other countries.

Medicare Part D Prescription Drug Negotiation and Formulary

The Veterans Health Administration (VHA) pays 40% less for pharmaceuticals than Medicare does. The VHA has the power to negotiate drug prices and has its own drug formulary. While Medicare has neither, it does benefit from existing negotiation used by private insurers. Still, it is possible that a more large-scale negotiation by Medicare itself may result in cost savings for beneficiaries. A bill that would allow for that process has already been introduced by Senator Amy Klobuchar of Minnesota and Representative Peter Welch of Vermont. By allowing Medicare Part D to utilize the same tools as the VHA, we may be able to reduce costs for taxpayers.

Addressing the Opioid Crisis

Prevention

As has been requested by 35 State Attorneys General, Congress should require that health insurance plans provide coverage for non-opioid pain treatments. Health care providers certainly need to do more to ensure they are prescribing appropriately, but the reality is that the conversations between patients and providers about alternative methods for pain treatment often don’t happen because of outdated insurance policies. In most cases, patients know that their insurance company will cover a bottle of opioids; but will not be as generous in covering sessions of physical therapy or nutritionist consultations that could be needed to truly address the root of a patient’s pain.

Treatment

Many individuals experience an opioid overdose before realizing they need or being encouraged to seek treatment for their addiction. First responders like law enforcement officers, emergency medical technicians, and firefighters are responding to an increasingly large number of medical calls for drug overdoses. Many states and localities have allowed or required these first responders to carry naloxone, the opioid-equivalent of an EpiPen for allergies, to immediately reverse the overdose of these individuals. However, we must ensure that all first responders are legally allowed to carry this medicine and allocate funding to help them do so.

A Better Approach to Mental Illness

Untreated mental illness can often lead to drug addiction, crime, and suicide and costs America more than $300 billion a year. As a country, we need to move in the direction of treating mental illnesses as a health issue the same way we treat other chronic diseases—with a focus on the causes, not just the effects—and provide money in innovation and execution for this work. Americans with mental illness should have access to appropriate medications, evidence-based services, and treatment.