How to achieve health for all? The issue still divides lawmakers


WASHINGTON — Democrats and Republicans in Congress may disagree on the best way to achieve universal health insurance coverage, but there’s one thing they can agree on: health care system consolidation n won’t help.

“After the ACA [Affordable Care Act] was enacted between 2009 and 2014, hospital consolidation increased, hospitals acquiring physician practices increased,” Brian Blase, PhD, president of the Paragon Health Institute in Ponte Vedra, Fla., said Thursday in response to a question. of Rep. Jim Banks (R-Ind.) during a House hearing on universal coverage. The hearing was organized by the House Education and Labor Subcommittee on Health, Employment, Labor and Pensions.

“One of the issues when hospitals acquire medical practices is that you get referrals within that hospital system with no competition,” Blase said. “It’s a clear agreement in healthcare economics that consolidation raises prices significantly.” He recommended that Congress authorize the Federal Trade Commission (FTC) to review mergers of nonprofit institutions, including those in the healthcare industry, which it is currently prohibited from doing.

Rep. Pramila Jayapal (D-Wash.), Member of the Education and Labor Committee at Large, agreed. “I share Rep. Banks’ concern about hospital consolidation driving up health care costs,” she said. “And Mr. Blase’s suggestion that the FTC be able to review mergers between nonprofits is actually exactly what my next bill would do — it’s something that I think will benefit tremendous bipartisan support.”

But opinions varied widely on the main issue of the day: how to ensure that every American has health insurance coverage. “More government intervention will not reduce the cost of health care,” said Rep. Rick Allen (R-Ga.), a ranking member of the subcommittee. “The best way to make health care affordable would be to increase the use of association health plans. These plans have the power to save Americans up to 50% on health care costs by allowing small businesses to come together to offer lower cost health insurance.”

Rep. Andy Levin (D-Mich.) disagreed. “Health care is an absolute necessity. It’s a basic human right,” he said. “This pandemic has illustrated the importance of quick and easy access to life-saving remedies and preventive medications, but the question remains, if we can make COVID vaccines widely available and free at the point of use, why can’t we not do the same for other remedies and treatments? And we still have, despite our best efforts, 30 million uninsured people. There is no doubt that we need Medicare for All, a national health program to provide everyone with excellent health care, from birth to birth. they die.”

Robert Reich, former Secretary of Labor under President Clinton, pointed out that health care is becoming less affordable, even for the insured. “It would be hard to invent a more expensive and less efficient healthcare system than the one we have here in the United States,” Reich said. “Even before the pandemic, the typical American family was spending over $6,000 a year on health insurance premiums. If you add in the copayments and deductibles that doctors, hospitals, and drug companies also charge, that sum jumps to $6,400. typical pharmaceutical outlays, and that’s at least $6,800.”

And that’s not even the end, he continued, “because some of the taxes the typical family pays are also for health care — for Medicare and Medicaid and the Affordable Care Act. Add- and the typical household pays $8,975 a year for health insurance,” and that still doesn’t include what their employers pay for their health insurance premiums, money that might otherwise have gone to employee salaries.

Yet, despite spending more than twice the average amount on health care compared to the world’s other 35 advanced nations, “the United States ranks last among advanced nations in life expectancy and infant mortality. “, said Reich. “Americans are sicker, our lives are shorter, and we have more chronic illnesses.”

Replacing private, for-profit insurance with a Medicare for All system “would lead to much lower total costs, including premiums, copayments, deductibles, and taxes,” he concluded. “And that would cover all Americans. People could keep their same doctor or other health care provider and could buy private insurance to supplement that, just like some people now buy private insurance to supplement Medicare.”

Committee members also expressed concerns about certain elements of the current system, such as the high price of prescription drugs. “We saw [drug] costs continue to rise at rates much faster than inflation — prices that have become seemingly divorced from innovation, with even previously inexpensive generic drugs subject to random change,” said Rep. Lucy McBath (D-Ga.) “These are life-saving drugs, which myself, as a two-time breast cancer survivor, have had the advantage of being able to use. People have to make unthinkable decisions to buy their medicine or put food on the table or gas in their car.”

“People in America are just sick of seeing endless price increases while pharmaceutical companies are posting record profits,” she added. “We know this market needs to be reformed.”

Representative Virginia Foxx (RN.C.), a leading member of the entire Education and Labor Committee, echoed a comment by Blase that life expectancy in the United States fell in 2019 compared to 2013 “despite the significant increase in government health expenditure and the implementation of the [Affordable Care Act’s] Medicaid expansion… What does this decline in life expectancy say about the effect of government health programs and health spending?” she asked.

Blase replied that “there are a lot of differences that explain this, that surround behavior, social circumstances and genetics – it’s really not an indictment of this health care system.” He noted that despite declining life expectancies, the United States is much better at certain health functions, such as treating cancer. “Where do you want to be if you have cancer? You want to be in the United States”, where cancer survival rates are much better than in Europe.

  • Joyce Frieden oversees MedPage Today’s coverage in Washington, including stories about Congress, the White House, the Supreme Court, professional health associations and federal agencies. She has 35 years of experience in health policy. To follow

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