As summer wanes and fall begins to come into focus, it’s time to look ahead to the healthcare legislative issues that could come into play. With campaigns heating up and the debates beginning, you can guarantee that promises will be made and accusations leveled concerning your healthcare. Some of the issues that will be brought up might have a small chance of actually being implemented, but this doesn’t mean that we shouldn’t pay attention. In the past, seemingly long shot proposals have become late night trading fodder when politicians make deals on far reaching legislation. Many of the issues I’ll talk about today were thought to be not-starters a few years ago and now they are political realities. What I will do is offer a simple explanation of each issue, give you an idea on how it could affect you and how likely I think it will be to be implemented. I’ve written an earlier blog about many of these issues. You can look through recent posts to get a more detailed explanation of some of the issues.
International Pricing Index/Favored Nation Pricing
Background – In an effort to lower drug costs some in Washington (most recently the President) have proposed that we fix the cost of a drug to the lowest price a “favored nation” paid. As I’ve explained before, price fixing has never been a long-term solution to any cost problem. There are better ways to have other nations share in the costly research and development that goes into discovering and manufacturing prescription drugs.
Impact – If this approach is implemented the supply line safety that we have enjoyed over the years will be jeopardized with no guarantee that any savings will make its way to you.
Chance of Implementation – While this idea has been around for at least a couple of years, its chances of becoming a reality have gone up. It would be difficult to implement and the chance of unintended consequences high. This makes its implementation politically unpopular but a great thing to talk about during debates.
Background – This issue has some of the same characteristics as the international pricing index. The goal is again to lower drug prices by allowing importation of these drugs from Canada. I talked about this proposal in my earlier blog explaining how it bypasses the safety net we now enjoy without any proof that the patient will see any savings while counting on Canada to implement a program that they have already said they can’t support.
Impact – While you or someone you know has gone across either our southern or northern boarders to purchase medicine at a lower price, this is not what this proposal is about. This importation proposal is at a much higher-level involving suppliers and transporters and large volumes. Some states have passed laws allowing importation but none of them have been implemented.
Chance of Implementation – This approach has been around for many years and no one yet has found a way to safely implement it. A pilot program of some sort may be started but it will take some real political will to make it happen. Canadian officials have indicated they will not support it. However, the chances of it happening are much more likely than they were just a few years ago. This is one of those solutions that may gain some traction.
Changes to Medicare Part B
Background – The price of drugs administered and paid for under Medicare Part B have increased substantially. These are drugs that are often injected at a doctor’s office for serious diseases like cancer and many types of autoimmune diseases. A proposal to fix the cost of these medicines has been put forth. This approach would go against the market-based approach that is now in place. It would impact many of the doctors who perform these services and upend and regulate this vitally important portion of our healthcare. Again, fixing prices has never been and efficient, long range solution.
Impact – If implemented, this approach would change the economics of this vital service. Any savings to the patient has been hard to quantify but it would most certainly put pressure on already pressured neighborhood practices. Losing these close, more accessible, services would have serious consequences.
Chance of Implementation – Part B drug prices have become a focal point for people seeking solutions to increased costs. We need to correct the underlying parts of the system rather than using a sledgehammer to bludgeon one part of the business.
Part D Cap
Background – Almost all of us, either in private insurance or Medicare or Medicare supplemental insurance, have experienced caps on our healthcare out-of-pocket costs. It helped us budget our money, we even decided what type of insurance to buy based on the yearly cost caps. Medicare Part D has no such caps. Depending on what prescription drugs, we need we may have out-of-pocket costs that balloon to the tens of thousands a year.
Impact – While we have been against the other proposed changes, a Medicare Part D cap would have a huge impact on those of us who are already retired and everyone younger as they plan for their retirement. I’ve known people, maybe you have also, who were living comfortably until an illness struck and their drug costs forced them to tap into their retirement. The peace of mind that a cap on our drug costs would give all of us, whether planning for or already retired, would be immense. This a change that is worth fighting for.
Chance of Implementation – This change is gaining some traction. While it probably won’t be something that is done on its own, it is a change that could be incorporated in some larger legislation as a balance or concession to reach final approval on the bigger legislation. It would be a most welcome change.
It is guaranteed that there will be other changes to our healthcare put forth as we near election day. We will keep you up to date on each one, explaining in simple terms what the change is and its impact on you. There is one over all criteria that I would like you to consider. Making short term, knee jerk, politically popular, changes is not the answer. Trying to band aid or quick fix a broken process never ends well. We need to fix the underlying problem, simplify the process, and let the free market drive us to the most effective, cost efficient solution. I believe the reduction of administrative overhead and regulations is a big step toward this goal. Measure each change to see if it offers simplicity and transparency in its solution.
Let’s stay informed as we approach this critical election. Get involved, tell those in Washington how you feel. Also, get registered to vote and then vote! It’s one of the most powerful things we can do.