Iowa View: Let's Repair Health Care

Op-Ed

By David Young

Recently, President Obama delayed the full enforcement of the Affordable Care Act's employer mandate provision until 2016. Yet, the administration still insists on enforcing the individual mandate, which began earlier this year.

Arguments surrounding the policy implications of these mandates are complex, but easing the employer mandate and enforcing the individual mandate illustrates the federal government's favoritism toward corporations over individuals. Our government is forgetting the intrinsic value of the individual.

Instead of mandates, we need free-market principles to ensure more people receive coverage. The core problem with the Affordable Care Act is not that it attempts to insure more people, but that it makes the attempt without fixing our health care system or decreasing the cost of health care. According to the Congressional Budget Office, the Affordable Care Act still leaves 26 million people uninsured.

A fundamental way to lower costs across health care is price transparency. Health care consumers have virtually no ability to identify service costs in advance. Lack of price transparency reduces competition and consumer choice while increasing costs.

Even though complexities in government and private sector reimbursement have led to this, providers receiving federal health care dollars should publish average prices and consumer cost-sharing estimates for common services. According to a 2012 study by Thomson Reuters, in the employer-sponsored health insurance sector alone, price transparency initiatives would save about $36 billion a year by reducing price variation associated with a lack of transparency.

There are other methods to help lower health care costs. These include expanding health savings accounts, enacting tort reform and allowing individuals to purchase health insurance with pre-tax dollars as is already allowed for employer-sponsored plans. We could also establish high-risk pools and reinsurance to insure those with pre-existing conditions.

Foremost, we should allow individuals to purchase health insurance across state lines much like consumers purchase automobile insurance or insurance on their homes. Permitting these purchases across state lines will lower premiums between 5 and 8 percent, according to the Congressional Budget Office.

The Medicare Hospital Insurance Trust Fund will be insolvent in 2026, according to the chief actuary for the Centers for Medicare and Medicaid Services. Other parts of Medicare also face solvency issues. According to the Kaiser Family Foundation, Medicare cost taxpayers $546 billion in 2012. Medicare must be part of the discussion on lowering health care costs. Congress must think creatively and use ideas that maintain Medicare beneficiary access and improve the quality of care at a cost beneficiaries can afford to ensure the program's viability and promise to seniors.

A number of steps should be taken to improve Medicare solvency, such as establishing site neutrality. Hospital outpatient clinics are reimbursed much more than free-standing physician clinics for the same services in the same geographic areas, eliminating fair competition. This just does not make sense. Generally, Medicare reimbursement should pay the same for services regardless of the care setting. According to the nonpartisan Medicare Payment Advisory Board, this would decrease cost-sharing for beneficiaries while saving Medicare billions of dollars.

Also, Medicare only pays for 2-D mammograms to prevent breast cancer. 3-D mammograms save more lives than 2-D mammograms because they provide sharper images. This then saves money -- but more important, it saves lives -- because the technology reduces the amount of callbacks and retesting needed to clarify a diagnosis by 50 percent.

Both 3-D mammograms and site neutrality would save Medicare money while increasing quality of care for women and seniors.

We must work tirelessly to make our federal government solvent. Health care is an important piece of this overall puzzle. To get real solutions enacted, we must think outside the box and we must work together.

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