How DOGE Should Help Americans
Keeping up with the decimation of government health programs has consumed the energy of EverythingHealth these past weeks. It has been too much, too drastic and too chaotic to address all at once. So lets just take one aspect of government spending that affects every American's pocketbook...The Cost of HealthCare and Drugs.
If Doge really wanted to bring down cost, there are some measures that could be taken and that would have bipartisan support, not to mention the support of 70% of Americans who reported feeling that the health care system was failing to meet their needs. Here is what I would tackle first:
PBM (Pharmacy Benefit Managers)- These middlemen distort the pharmacy market for EVERYONE. PBMs are mainly owned by 4 large companies (CVS, United Healthcare, Humana and Cigna) and they manage prescription drug benefits for Medicare, pharmacies, insurers and pharmaceutical manufacturers. This is a major problem because they reap the benefits of discounts from the drug manufacturers, getting lower pricing from pharmacies and creating formularies for the insurance plans. They own the mail order pharmacies and they charge steep markups, keeping the negotiated rebates and profits. They steer patients towards pricier drugs and there is no transparency into their business model or how they operate. Apparantly pharma reforms had almost unanimouse house support (both Democrat and GOP) to pass a bill to reign in PBMs until Elon Musk posted a tweet complaining about the bill. It died immediately.
Reform Private Equity takeover of health care - Private Equity (PE) investors have consolidated physician practices and taken over struggling hospitals with a single goal of generating short term profits. It is making a lot of investors and wealth managers very rich with the result of declining physician workforce, lower quality and rising costs. According to a Harvard study published in JAMA (12/26/2023), private equity acquisitions led to higher charges, prices and lowered quality of care for patients. Physician practices weren't included in the study becauase only PE aquisitions over $111.4 million have to be reported. And PE takeover of small hospitals does not require reporting to DHS so often it flys under the radar. Emergency medicine, anesthesia, ophthalmology, orthopedics, urology, gastroenterology and cardiology groups are being snapped up by the sell-out money offered by PE. Private equity firms now own more than half of all specialists in certain U.S. markets. They consoliate small private practices into larger conglomerates and drive up prices and employ nurses to replace physicians. Private equity ownership of nursing homes has shown lower staffing levels and higher prescriptions for antipsychotic medicines. Get PE out of healthcare or at least have some guardrails.
Expand, don't cut Medicaid - Most states will not be able to fund Medicaid without federal matching grants. Here are some little known facts:
*Most people on Medicaid are working.
*Medicaid does not cover undocumented immigrants
*20 million people will be uninsured without Medicaid if the match rate is eliminated.
*Cuts to Medicaid affect rural hospitals and providers that are already short-changed.
*Medicaid pays for nursing home care for low-income, elderly and disabled people.
*Over 9/10 adults say Medicaid is important to their local communities
*Medicaid expansion is tied to early stage cancer diagnosis, lower mortality and
reduced hospital stays.
We need more Medicaid, not less. Or a completely reformed Insurance market so working people can afford health care in the US.
End Surprise Medical Bills- Does anyone think they understand medical billing? Believe me, your doctor doesn't have any better insight into surprise medical bills than you do. Trump promised to end surprise medical bills. The office working on that just got slashed by Doge. The Federal Center for Consumer Information and Insurance Oversight (CCIIO) was charged with enforcing the "No surprise Act", passed by congress in 2020. In 2023 more than 650,000 disputes were filed by patients whe were targeted by a surprise bill. No one will be following up on those complaints now.
Eliminate Drug Ads on TV - We stopped broadcast advertising for cigarettes in 1971. Admittedly, the tobacco folks just advertised more in magazines, newspapers and billboards, but cigarette smoking has decreased by 73% among adults due to public awareness of the extreme dangers of smoking. The US and New Zeland are the only two countries that allow pharmaceutical advertising directly to patients. $6.58 billion was spent annually on advertising in 2020. Notice that the ads are for expensive branded medications, which drives inappropriate drug prescribing. There is absolutely no reason for pharma to directly advertise expensive prescription drugs to patients, except to make big Pharma even more profitable. And to pay for expensive lobbyists to curry favor with polititians.
I could do part 2 ,3 and 4 but that's enough for one reading. Everyone agrees with eliminating fraud, waste and government inefficiencies. So far I havent seen any Doge cuts that achieve that goal. If chaos, causing world disease and hunger, increasing unemployed ranks, eliminating consumer protections, making America sicker and more anxious is the goal...it is being achieved. Stay tuned.
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