Vital Questions to Raise While Evaluating Health Care Reform Policies

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Several questions are popping up among the people’s mind and a lot of competing ideas are originating while thinking of the best way to reshape and reform the health care system. Whether a single-payer, Medicare for all, Medicare for more, ACA repeal, or some other way to reform the healthcare, is the most talked about and debated issues among the state and national level legislators. Developing a clear vision for healthcare reform is extremely hard, mainly because healthcare is a vague and encompassing term. Perhaps some health care reforms aim to reduce healthcare costs, while others aim to eliminate barriers and increase healthcare access.

It is commonly observed that people describe health plans with terms like universal coverage, single-payer, public option, Medicare for All, market-based reforms, and pre-existing conditions protections. However, people get confused after listening to the news, watching debates, or attending public forums, regarding their plan coverage, and are unable to distinguish between the benefits of the plans. There are some vital questions that policymakers and the constituents voting for them should consider while estimating a proposal for a health care reform along with the benefits and trade-offs of diverse responses.

How the healthcare costs should be shared between the sick and the healthy?

Medicare for All common critique is the increase in government spending, and resulting in taxes on Americans. However, for some of the people, the increased tax amount can be compensated by the decrease in out-of-pocket spending, but this will not be applicable for all. The amount of shared healthcare costs depends on the amount shared by the people of different health statuses in the total health care costs of the population. This can be understood with an example, people enrolled in a health plan covering few benefits or requiring lots of out-of-pocket spending when accessing healthcare does not spread health care risk much as compared to large numbers of people contributing to a comprehensive health plan spread. Large numbers of enrollees having their health plan with low health care risk do not broadly spread costs, whereas large numbers of people having diverse health care risk broadly spread costs. The market-based system presently uses segmented systems of risk and accordingly price is calculated, whereas a single-payer system is likely to spread the risk across the entire insured population.

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Is reaching true universal coverage important and the number of U.S. residents that must be insured?

In true universal coverage, everyone is covered through health insurance whether they wished to be covered or not. To encourage people enrollment in health plans, the ACA offered both financial incentives as well as imposed penalties. Despite incentives and penalties, still many Americans are uninsured due to a variety of reasons.

Truly universal coverage would offer coverage to all through methods like greater financial incentives and automatic enrollment. However, the trade-offs become political repercussion associated with forced participation of the people and requiring them to contribute to the costs through premiums or taxes against leaving some of the people uninsured, that will result in uncompensated care and unfulfilling medical needs.

How generously government should finance premium subsidies and cost-sharing?

The major issue with the present healthcare system is the high cost of healthcare. The monthly insurance premium for people who never visit a doctor can also be a financial burden. The several reform efforts increase the cost burden through government subsidies, but the big concern is about the amount of funding that should be distributed. A certain amount of government funding can either be focused on low-or-middle income groups or can be spread among all income groups. If the subsidies are focused on a low-or middle-income group will largely affect affordability and chance of voluntary enrollment, but political support for reform may expand coverage among high-income groups if they can also expect to receive assistance from the government.

Who should finance the healthcare reform proposal?

The main point of debate of any healthcare reform proposal is how reform options should be financed and who should foot the bills. Whether consumers should pay premiums or the healthcare cost should be exclusively paid through tax revenues. It should be taken into account that premium financing spreads the insurance coverage costs broadly among enrollees. This conveys a message that individuals should take responsibility and finance their care, thereby reducing the need for politically unpopular tax increases. However, premium alone is not sufficient to develop systems to provide adequate and affordable coverage to low-and-middle-income people.

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Is there should be regulations to limit the prices of different health plans, and if yes then how should prices be set and how broadly those regulations should apply?

In 2018, the U.S. spent $3.6 trillion annually on health care. This was considered by everyone as inflated prices ranging from drug manufacturers to insurance companies, to large health care systems coming under fire. Medicare and Medicaid have currently capped the reimbursement rates for providers. This move is expected to be expanded, as the issue is to balance government regulation with the free-market competition. While set rates could result in lower costs across consumers, it may hurt providers and reduce innovation in healthcare.

If lower prices are set for the providers, then there will be a greater reduction in healthcare costs and there will be lower-income healthcare providers. It is difficult to know about the price level that would balance the quality of care, cost containment, and access to care. Besides, if the regulated price applies to more people, then the prices may need to be higher to reduce concerns regarding access and quality. With a good understanding of the possible answer to the above questions, consumers can better understand the present healthcare reform proposals and can bring forward their ideas on future proposals. Educated consumers should be aware that there is no perfect solution and all reform will come with both advantages and disadvantages, as well as gain and losses. The challenge is to find a policy that broadly represents an accepted set of trade-offs.

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