Democrats are having the wrong Healthcare Debate

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Current issues with Healthcare in America.

This week’s conversation is based on an article which appeared in the New York Times on August 2 of 2019. The article was an essay by Dr. Ezekiel Emanuel, a physician and the provost of the University of Pennsylvania.

Dr. Emanuel watched the first two debates among the Democratic candidates for President. After listening to their discussions regarding proposals for health care changes in America, Dr. Emanuel concluded that they are all going in the wrong direction with their proposals. He now offers a proposal of his own.

We intend to share his concerns with you this week and provide Dr. Maupin’s response to them. Our goal is to provide information you can use to help make decisions about your own health care and about which candidate, if any, that you might support.

  1. The first topic he discusses is the need to address drug prices.
  2. Hospital prices are soaring and must be contained.
  3. We need a policy that targets wasteful insurance billing practices.
  4. Finally, we need to find a way to switch from fee for service approaches to the provision of medical services to some kind of value-based alternatives.

Dr. Emanuel provides an explanation for each of these proposals he is making. Dr. Maupin responds with a physicians’ response. Her first reaction was to the idea of an unfunded mandate by the government in an effort to solve or address any of these approaches. Her concern here is  that when we make governmental decisions that come as unfunded mandates (meaning that Congress does not provide a method for paying for the behavior that now becomes legally required) these mandates impose both labor and cost factors on health care providers that make it virtually impossible for doctors to keep their offices open and to provide various medical procedures that people need in order to live and be healthy. An example of that would be the use of EMR’s these systems, called electronic medical records, were required by the federal government as a way to make it easier for people to access their records and share those records with whomever they thought would be appropriate. This was all in the name of privacy and efficiency. Doctors and hospitals around America had to spend millions of dollars on the development and use of these systems. That money had to come out of their practice and none of that money went directly into the provision of medical care for patients directly. This raises the cost for administrative processes and benefits insurance companies and government record keepers but does not benefit your health directly while at the same time negatively impacting the financial health of the practice or hospital.

Another problem we look at is that pharmacy benefits managers and insurance companies are in effect practicing medicine without a license when they set limits on the drugs you can get from the insurance company, or their formularies in spite of what your doctor tells you that you need medically. The federal government so far, has not found a way to address that situation.

One of the things that Dr. Emanuel suggests would help the medical delivery and health care systems in the United States would be to have the government negotiate with the drug companies to lower the cost of those drugs to people. Right now, Medicare is not allowed because of a congressional law, to negotiate with drug makers for lower or bulk prices. If we were able to do that alone, he says we could save over 53 Billion dollars a year.

Dr. Maupin has some suggestions to go along with negotiating for drug prices, including the existence of compounding pharmacies, and she talks about the strategy of the FDA for licensing and regulating drugs and makes some suggestions regarding how that process ought to change.

These discussions are frustrating because we feel so powerless to change the system. The vested interests work very hard to stay in power. We do not know that we have the right answer or the best answer, but we believe that we need to try something and that some of these options deserve to be considered and, where possible, tried.

We encourage you to be an informed consumer when it comes to your own health care and we encourage you to become more politically active in approaching and supporting candidates that will listen to you and vote for the things you want.

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author.

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