How to Achieve Healthcare for All? Question Still Divides Lawmakers – MedPage Today

WASHINGTON — Democrats and Republicans in Congress may disagree on the best way to achieve universal health insurance coverage, but there is one thing they can agree on: health system consolidation 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, Florida, said Thursday in response to a question from Rep. Jim Banks (R-Ind.) at a House hearing on universal coverage. The hearing was held by the House Education and Labor Subcommittee on Health, Employment, Labor, and Pensions.

“When hospitals acquire physician practices, one of the problems is you get referrals within that hospital system without competition,” said Blase. “It is a clear agreement across health economics that consolidation significantly increases prices.” He recommended that Congress allow the Federal Trade Commission (FTC) to scrutinize mergers of nonprofit institutions, including those in healthcare, something it is currently barred from doing.

Rep. Pramila Jayapal (D-Wash.), a member of the full Education and Labor Committee, agreed. “I share Rep. Banks’s concern about hospital consolidation increasing healthcare costs,” she said. “And Mr. Blase’s suggestion that the FTC be able to scrutinize mergers among nonprofits is actually exactly what my forthcoming bill would do — that’s something I think will have tremendous bipartisan support.”

But opinions varied greatly on the main question of the day: how to make sure every American has health insurance coverage. “More government intervention won’t decrease the cost of healthcare,” said Rep. Rick Allen (R-Ga.), the subcommittee’s ranking member. “The best way to make healthcare affordable would be to increase the use of association health plans. These plans have the power to save Americans up to 50% on healthcare costs by allowing small businesses to band together to offer lower-cost health insurance.”

Rep. Andy Levin (D-Mich.) disagreed. “Healthcare is an absolute necessity. It’s a fundamental human right,” he said. “This pandemic has illustrated the importance of quick and easy access to life-saving cures and preventive medicines, but the question remains, if we can make COVID vaccines widely available and free at the point of use, why can’t we do the same for other cures and treatments? And we still have, despite all of our efforts, 30 million people uninsured. There’s just no question that we need Medicare for All, a national health program to afford everyone excellent healthcare from when they’re born to when they die.”

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

And that’s not even the end of it, he continued, “because some of the taxes the typical family pays are for healthcare too — for Medicare and Medicaid and the Affordable Care Act. Add them in and the typical household pays $8,975 a year for health insurance,” and that’s still not including what their employers pay toward their health insurance premiums, money that might otherwise have gone to employees’ wages.

Yet despite spending more than twice the average amount on healthcare compared with the world’s other 35 advanced nations, “the United States ranks near the bottom among advanced nations for life span and infant mortality,” Reich said. “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 far lower total costs, including premiums, copayments, deductibles, and taxes,” he concluded. “And it would cover all Americans. People could keep their same doctor or other healthcare provider and could buy private insurance to supplement it, just as some people now buy private insurance to supplement Medicare.”

Committee members also expressed concern about specific parts of the current system, such as the high price of prescription drugs. “We’ve seen [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 changes,” said Rep. Lucy McBath (D-Ga.). “These are life-saving medications, which I myself, as a two-time breast cancer survivor, have had the advantage to be able to use. People are having to make unthinkable decisions about whether to purchase their medications or put food on the table or gas in their car.”

“In America, people are just sick and tired of seeing endless price increases, while pharmaceutical companies see record profits,” she added. “We know that this market needs reform.”

Rep. Virginia Foxx (R-N.C.), ranking member of the full Education and Labor Committee, picked up on a comment by Blase that life expectancy in the U.S. dropped in 2019 compared with 2013 “despite the significant rise in government healthcare spending and the implementation of the [Affordable Care Act’s] Medicaid expansion … What does this drop in life expectancy say about the effect of government healthcare programs and spending on health?” she asked.

Blase replied that “there are a lot of differences that account for that, that surround behavior, social circumstances, and genetics — that’s really not an indictment on this healthcare system.” He noted that despite the life expectancy drop, the U.S. is a lot better at some healthcare functions, such as treating cancer. “Where do you want to be if you have cancer? You want to be in the U.S.,” where cancer survival rates are much better than in Europe.

Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow