Innovation, Not Medicaid Expansion, is the Right Health Care Reform
The following op-ed was published this past weekend in the Salt Lake Tribune.
Political support for Medicaid expansion in Utah is on life support and the prognosis may be terminal. However, this doesn’t mean there isn’t a pathway forward for those looking for health care solutions. That pathway is the same one that has solved many of our problems — innovation.
Each Medicaid expansion proposal has been a reaction to the failure of federal policy in attempting to address the “coverage gap.” But the gap is only a symptom of the underlying disease. The Affordable Care Act did little to actually make care affordable. In fact, it aggravated the very conditions that have driven health care costs up: regulation and government intervention. Obamacare put more patients into the system with no corresponding increase in practitioners, while also forcing insurance plans to cover more services —making them less like insurance and more like full service warranties.
We now expect our health insurance to pay for every medical service we use and yet are shocked when its cost becomes unaffordable. We don’t expect our car insurance to pay for oil changes or our homeowners insurance to pay for lawn service — why do we expect our health insurance to pay for routine doctor visits?
Utah is a business-friendly place for innovation and yet many of our neighbors travel to foreign countries to take advantage of 50 percent to 80 percent discounts on procedures in less regulated markets. Instead of turning Utahns into medical refugees, we should offer a deregulated alternative to attract medical tourists to Utah.
Instead of policy-makers negotiating over how to pay for federally qualified health insurance plans, let’s address the root problem of unaffordable care by adopting patient-centered, market-based reforms and finding ways to reduce the burdens of regulation on the healthcare market. If successful, we could create a true “Utah solution” giving patients and providers a right to try an alternative, parallel marketplace exempt from certain burdensome regulations.
We can start by reducing the barriers to entry for health care professionals along with the burdens of licensure and limits on scope of practice. We can reduce barriers on concierge and telemedicine, direct-pay models, out-of-state practitioners, medical cost-sharing and charity care. We can explore options for consumers to opt for service agreements that incorporate certain tort reforms and damage caps. We can also deregulate insurance plans in Utah for those that are exempt from Obamacare.
We need to rethink the roles that our practitioners and care delivery platforms play, and allow deregulation to facilitate decentralization and innovation. Just as today’s laptops and smartphones can deliver the services of yesterday’s mainframes, tomorrow’s neighborhood clinics, nurse practitioners and even smartphones can deliver the services of today’s hospitals.
Lower-cost venues and lower-cost providers should be allowed to do more sophisticated things. Instead, it seems that government protects the higher-cost venues and higher-cost providers through regulations that disallow certain services to be offered by lower cost providers who are not members of the protected guild.
Our health care markets have become so expensive that the poor are priced out. Rather than explore options to provide deregulated alternatives, like those available in the very places to which medical refugees flee, policy-makers are asked to just stick taxpayers with the bill for increasingly expensive and regulated care.
Utahns in the gap are actually in an opportunity zone. They are the only ones exempt from the individual mandate of Obamacare. By receiving a denial for Medicaid coverage, they are no longer penalized for not having a qualified health insurance plan. This means they can buy any type of health insurance or other alternative they choose. Instead of shackling them with a one-size-fits-all government insurance plan, we should allow the insurance market to innovate and offer them a plan that meets their needs and budget.
Utah’s “silicon slopes” showcases one of the fastest growing and yet most unregulated industries in history. Information technology has seen a rapid increase in quality and innovation with a substantial decline in cost, while the highly regulated healthcare industry has experienced the complete opposite.
Like all of humanity’s great problems, the solution for health care does not lie in a new government program or mandate, but rather in the collective ingenuity of humanity — an ingenuity unshackled by the programs and mandates of government. Let’s give innovation a try.