Political junkies will find the next ten months euphoric indeed. Not only are we in a presidential election year. Not only is there more partisan conflict than anybody alive today can remember. But there’s more at stake for the future of the country than at any time since the 1930’s. And nothing is as central to political debate as the future of health care, and specifically health care costs.
Now, we’re sure to hear a lot of blather about one or another scheme to rein in costs in an ideologically acceptable (i.e. market-based) manner. No doubt, some approaches would be better than others. But any approach that doesn’t effectively address the underlying drivers of health care costs – pharmaceuticals, diagnostic tests, complex equipment and procedures – in the context of aging population dynamics (1.5 million seniors signing onto Medicare per month) is doomed to failure.
So what is to be done? Here are four starter ideas: (1) End the current restriction preventing Medicare from using its vast potential bargaining leverage to get low-cost drugs for recipients. (2) Make health insurers subject to antitrust laws (they’re currently immune) to promote meaningful competition. (3) Allow a Medicare-like public option, open to everyone (to label a public option “socialist” is disingenuous in the extreme; private insurers fear the real competition “Medicare for all” would pose). (4) Encourage/reward plans that emphasize disease prevention over expensive diagnostic and clinical intervention procedures.
We’re not likely to hear any of the leading presidential candidates promoting these ideas (Obama is committed to defending the Affordable Care Act, and Republican presidential contenders are committed to attacking Obama). But despite the sorry state of our republic these days, citizens still have a voice. Let’s use it.