The U.S. healthcare system is a mess. Premiums and deductibles are soaring. Consumers have fewer choices when it comes to doctors and hospitals. And the United States could be short 90,000 physicians within a decade.
Voters want to know how the next president will reverse these trends. Yet the 24 million Americans who tuned into August’s Republican presidential debate heard “health care” mentioned just twice. By comparison, the word “Trump” was uttered 28 times.
Republican candidates hoping to win the presidency would be wise to have answers to the following four questions ready at the next debate on September 16 at the Ronald Reagan Presidential Library.
Let’s start with the obvious: “How will you combat rising premiums?”
Next year, patients across the country will face stiff rate hikes. Oregon’s Moda Health Plan recently confirmed a 25 percent premium increase. Blue Cross Blue Shield affiliates are requesting increases ranging from 23 percent in Illinois to 54 percent in Minnesota.
Nationwide, premiums will increase an average of 12 percent next year, according to the online health insurance research tool HealthPocket. That’s a far cry from President Obama’s 2008 campaign promise to cut premiums by $2,500 for the average family.
The next president must find ways to make insurance more affordable.
A good place to start is by repealing Obamacare in its entirety. That would eliminate Obamacare’s onerous regulations on insurers, including “guaranteed issue” and “community rating.” These rules, which force insurers to sell policies to all comers regardless of health history or status and then control the prices they’re allowed to charge, have resulted in lower rates for the sick — and astronomical increases for the young and healthy.
A better way to provide affordable coverage to the sick is through state-based high-risk pools, which separate high-cost patients from the majority of reasonably healthy folks. That will create a functional, competitive insurance market for the latter group — and allow state officials to deploy targeted aid to the former group.
Second question: “How will you fix Medicare and Medicaid?”
The two entitlement programs are fiscal disasters. In 2013 alone, Medicare and Medicaid cost over $1 trillion — nearly 40 percent of what the United States spent on health care. By 2020, they’re on track to cost a whopping $688 billion and $466 billion, respectively.
Despite such spending, most enrollees can’t get past the waiting room. Only half of doctors are scheduling appointments with new Medicaid patients. According to a 2013 report by the Medicare Payment Advisory Commission, three in ten beneficiaries struggle to find a primary care doctor who accepts Medicare.
To reform these programs, the GOP presidential candidates should give states block grants to administer their Medicaid programs as they see fit. For Medicare, the presidential hopefuls should raise the program’s eligibility age and give seniors means-tested vouchers so they can take direct control of their care. Medicare beneficiaries should also be allowed to contribute to tax-advantaged Health Savings Accounts, which the IRS currently prohibits.
That leads to the third question: “How will you promote healthy competition among insurers?”
Insurers are merging rapidly. This summer, Aetna purchased Humana, and Anthem acquired Cigna. The Big Five national insurance companies could soon be just three. That will mean less competition and higher prices for patients.
To counterbalance these effects, patients should be allowed to purchase insurance across state lines. They could then shop around for the best deal and provide insurers with an incentive to scale back prices.
And question four: “How will you give individual Americans more control over their health care?”
Obamacare has squashed consumers’ healthcare choices. The average exchange enrollee has access to 32 percent fewer primary care doctors and 24 percent fewer hospitals than the average person covered by conventional private insurance.
That needs to change.
Fortunately, Wisconsin Governor Scott Walker has started the conversation by introducing the first detailed replacement plan for Obamacare among the GOP candidates. The rest of the field should let voters know whether they agree with Gov. Walker — or articulate their own visions for health reform.
American voters want to know how presidential hopefuls will fix our nation’s broken healthcare system. The winner of the next GOP debate will be the one with an answer.
Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The Cure for Obamacare (Encounter 2013).
