Header graphic for print
Dangerous Drugs & Medical Devices News & Commentary on Prescription Drug & Medical Device Lawsuits

Several Avenues for Healthcare Reform Outined

Posted in Politics

A recent article from Slate.com by Matthew Yglesias provides an interesting overview of problems and solutions in health care reform.

Published Friday January 24th 2014, the report begins by citing a recent Gallup poll demonstrating a recent and dramatic decline in the number of Americans without health insurance.  Likely the result of the further implementation of the Affordable Care Act, Yglesias purports “that progress is likely to continue.”

With the increasing number of Americans receiving health insurance, we must also be mindful of the quality of that care received.  Yglesias cites a few positive reforms mandated by ACA, “designed to restrain aggregate health care spending, most notably by reforming the way Medicare pays medical providers.”  Though, the author notes that “health care spending has been slowing down in recent years, and there’s some evidence that Obamacare deserves the credit”, but “that slowdown was happening before the major expansion of insurance coverage kicked in.”

This is good news either way, but it doesn’t speak to whether the current healthcare system is as yet capable of handling millions of new, recently-insured patients.  Yglesias writes “The Affordable Care Act relies on Medicaid expansion to cover many new people because Medicaid is one of the cheapest ways to deliver health insurance. But the main reason it’s so cheap is that its payments to health care providers are relatively stingy. Since the payments are stingy, some providers refuse to treat Medicaid patients. Since Obamacare gives non-Medicaid insurance to many currently uninsured people, providers may actually find it easier than ever to fill their schedules with high-paying non-Medicaid customers—even at a time when Medicaid expansion means we need more providers.”

Next, Yglesias discusses the role of nurse practitioners in the healthcare system.  Currently, a number of states – the author cites Maryland, Rhode Island, Idaho, and Utah – “allow nurse practitioners to diagnose and treat a variety of ailments without a doctor’s involvement.”  And though larger states such as New York, Florida, California, and Texas do not, “Evidence suggests that health outcomes are no worse for patients treated by independent nurse practitioners.”  If more states allow nurses to work with increased autonomy, more patients would be able to be treated, and for less cost.  Further, the ability for states to produce, as it were, more healthcare professionals would rise dramatically, as, simply put, it is “easier to qualify as a nurse practitioner than as an M.D.”

Another issue noted to consider is the current trend for hospital mergers.  While in some cases justified, hospital mergers may create diminished competition leading to price gouging, even if only at the local level. “Federal antitrust regulators haven’t traditionally had much to say about the health care industry, but that needs to change.”

And finally, Yglesias advocates for an increased supply of doctors.  “American doctors are paid more than doctors in almost any other country, and yet we have fewer doctors per capita.”  Among the avenues for solution cited are relaxed immigration policies for foreign physicians, particularly general practitioners, and a call to train more doctors domestically. “Medical schools have gotten steadily more selective over the past generation rather than expanding with the size of the population, and Congress has refused to pony up the money to finance more residencies.”

Though passing legislation for any of these improvements will likely be difficult, a positive aspect to all of them is a lack of inherent political divide, as was the case with the Affordable Care Act.  Hopefully moving forward our country will create the capacity to treat all our nation’s sick, whatever their socioeconomic background.