Resolutions for a Happier New Year … or Not

Published January 1, 2005

While the talking heads slice and dice November’s election results, one thing is certain: Belaboring the minutiae of what happened in that election, and why it happened, distracts from important issues–health care among them.

Ownership Society

Private ownership of retirement plans has been a growing trend, giving even low- and middle-income individuals more control over their financial planning. Similarly, privately owned health savings accounts (HSAs) offer consumers dramatically increased control over their health care.

Millions of folks now own retirement savings in a 401k or individual retirement account (IRA). They also own their life insurance policies, their auto insurance, and their fire insurance. That sort of ownership should be the goal for health insurance as well.

If the new Bush administration fails to advance the idea of an above-the-line income tax credit for HSA premiums, the full potential of this ownership plan will be diminished.

Medicaid HSAs

The cost of Medicaid has been identified as the number one budget demon in many states and has begun to affect millions of deserving beneficiaries who are being subjected to increasingly rationed care, exemplified by programs such as Tennessee’s TennCare. The HSA concept deserves front-burner attention for the Medicaid population.

It is possible to rethink completely how states manage their programs and to consider allowing them to issue HSAs in lieu of the current government-run payment system. The same savings potential and management controls inherent in private-sector HSAs are also attainable for the states. This is an idea worth exploring.

Specialty Surgical Centers

A little-known provision in the 2003 Medicare Modernization Act called for an 18-month moratorium on physician and investor-owned specialty hospitals. The specialist approach appeared about 30 years ago and enabled patients to be admitted, treated, and discharged all in the same day. Today’s specialty medical centers offer consumers high-quality care, with better patient outcomes than those achieved by general hospitals.

The American Hospital Association and Federation of American Hospitals, unfamiliar and uncomfortable with the notion of competing for health care consumers, are lobbying to deny patients access to these innovative health care delivery options. If we are serious about improving the quality of our medical care, the moratorium must not be made permanent.

Information Technology

Information technology challenges in the health care realm include providing security, 24/7 accessibility, data sharing, and standardization of data, messages, and vocabulary. To make the transformation from a paper-driven system to electronic records, we will have to find the proper level of privacy protection while making patient records readily accessible to the medical professionals who need them.

Expanded use of information technology will present cultural and social challenges and require major changes in the way hospitals, payers, physicians, and patients interact. All concerned parties will have to work together and share responsibility to ensure the quality and privacy of patient information.

Drug Importation

The dialogue over prescription drug importation has become so short on facts that some people still think Canada can be our national drug store.

Such rhetoric so shook the Canadian government that the country’s Health Minister, Ujjal Dosanjh, told a Harvard Medical School audience on November 10, “[I]t is difficult for me to conceive how a small country like Canada could meet the prescription drug needs of approximately 180 million Americans without putting their own supply at serious risk. To me it is a matter of common sense that Canada cannot be the drug store of the United States. Neither American consumers nor Canadian suppliers should have any illusions otherwise.”

In response to this warning, importation advocates now want the U.S. federal government to impose price controls and other regulations that would force pharmaceutical companies to manufacture offshore for importation back to America. As the recent flu vaccine shortage makes clear, outsourcing our pharmaceutical production capacity and then restraining the industry with price controls is an emerging idea that should go back to the junk pile of intellectually exhausted ideas.

U.S. federal officials recently intercepted 439 packages of drugs sold by CanadaRx. The drugs actually came from Australia, Britain, France, Germany, New Zealand, and Switzerland. The prescription drugs had been shipped to the Grand Bahamas for distribution here. Some of the drugs were made in Japan, New Zealand, and Singapore.

Inter-State Insurance

In September, the Council for Affordable Health Insurance (CAHI) announced the results of a Zogby consumer poll that revealed 72 percent of Americans supported the idea of allowing individuals to purchase health insurance from firms in other states, provided those firms are state-regulated. Eighty-two percent of respondents said they would be likely to purchase a policy across state lines if they were paying exorbitant premiums in their home state.

The cost of health insurance in many states is much higher than necessary, in large part because of heavy-handed state mandates such as community rating (which effectively shifts the cost of insurance premiums from an older, less-healthy generation to the younger, healthier generation) and guaranteed-issue (which requires that all persons must be issued an insurance policy regardless of their health history or lifestyles).

As I described in an eight-part series for Health Care News (see “How Eight States Destroyed Their Individual Insurance Markets,”, such mandates have driven up premium costs to the point that millions of people have dropped insurance, pay severely inflated premiums, or rely on state-run Medicaid coverage. Unfortunately, current state and federal laws prohibit individuals from buying health insurance across state borders.

According to CAHI Director Merrill Matthews Jr., “Congress needs to take action to ensure that all Americans have other options. Judging by the results of this poll, Congress has the support to do just that.”

That would be a good start for a Happy New Year!

Conrad F. Meier ([email protected]) is senior fellow in health policy at The Heartland Institute.