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HHS head says we need Medicare for big system change

Written by Diane Archer

What does it take to drive big health care system change? Trump’s HHS head, Alex Azar, recognizes that commercial health plans do not have the power. Only Medicare and Medicaid can lead the way. Jessie Hellman reports for The Hill that Azar’s goal is to get insurers and providers to provide consumers health care cost information before getting care.

The inability or lack of desire of commercial insurers to drive down hospital costs has made care increasingly unaffordable for Americans. Moreover, unlike Medicare, commercial insurers have refused to make their hospital or doctor rates transparent, keeping Americans in the dark about the the cost of their care.

Azar says that patients have a right to know what a procedure will cost in advance of receiving it. Of course, they do.  Yet, it generally is not in the providers’ or insurers’ interests to disclose this information, or they would do so. There is ample evidence of consumer need and strong public pressure.

Powerful health care stakeholders put their financial interests ahead of consumer interests, because they can. It is hard to see how a few minutes of strong admonishments from Secretary Azar will make any difference, except perhaps from a public relations perspective. We need government regulations, which Azar says he supports if hospitals and insurers do not voluntarily disclose price information.

Azar also wants to do away with fee-for-service medicine and pay for “value.” He does not define what he means by value or how it would work. And, since the devil is in the details and no one has yet figured out how to pay for value for most services, that is concerning. But, Azar does recognize that when it comes to system reform, “Only Medicare and Medicaid have the heft, the market concentration, to drive this kind of change, to be a first mover.”

Improved Medicare for all is the best way to rein in costs and understand whether we are paying for value. Improved Medicare for all would provide everyone full coverage, without coinsurance and deductibles. It has the leverage to ensure provider rates are fair. Simply giving people price information is not nearly enough to bring down provider rates. People are usually not in a position to shop for their care, so knowing the price matters little. Moreover, rarely do we buy services based on price alone; quality matters as well.

Here’s more from Just Care:


1 Comment

  • It is possible to transition from a non-transparent, non-integrated, for-profit, non-market driven very cost-ineffective, non-Single Payer system to a united Single Payer (Modernized) Medicare System that is transparent, integrated, comprehensive (in utero to grave; with INTEGRATED public health / clinical prevention / outpatient / inpatient / ER/ urgent care / home / community / palliative care coverage), market-driven with minimal middleman interference of the doctor-patient relationship AND so cost-effective that it is entirely sustainable well into the next Century by:

    1) FIRST & FOREMOST recognizing and actualizing the component of the ACA that is currently dormant for lack of BIPARTISAN support: value- rather than fee for service-focused Direct Primary Care (DPC) with wrap-around catastrophic care coverage by a MUTUAL health insurance company using subsidized HSA’s connected to an HSA Bank that can facilitate investment of tax free in and tax free out HSA funds using techniques such as are used by the Federal Employee Health Insurance System;

    2) COMMUNITY (subsidized) support of the education, training and certification of care team members (Clinical Medical Assistants, Community Health Workers, Psychiatric Social Workers Apprentices / Health Care Navigators, Comparative Effectiveness & Continuity of Care Facilitators, Mesh-networking of HIT & ENERGY resources off the internet and off the energy grid Specialists, expanded SNOMED-CT Coders, concurrent to the visit Data Analyzers AND USA-prioritization of the cost-effective training of excellent, dedicated primary care provider professionals with advanced care degrees;

    3) A Payment System that unites transparent billings (using an expanded / automated / outcome-focused SNOMED-CT coding system) & payments to DPC + Direct Specialty Care + Population Health & Public Health Care + Urgent Care + Hospital Care + Home Care + Palliative Care using HSA’s that start in utero PLUS Community United Entrepreneurship PLUS Medicaid + TriCare + Active Service Care + VA Care + Non-Citizen Care using a Modernized Medicare Single Payer Patient System that obviates the need for PHARMA, Drug Distributor, Pharmacy Benefit Manager, For-profit (NON-MUTUAL) insurance company, Hospital System, EPICally pricing CEO’s, Private Doctor Office, Reference Lab, Private Testing Facility, Malpractice Lawyer choke-holds on costs, prices and allowable benefits;

    4) Intelligent / Integrated / Cost-effective Outcome focused EMR / EHR / HIE / CDS / PDS / CES / OMS / NFCA Health Information Management Technologies where:

    EMR = Electronic Medical Record that does not interfere with the doctor-patient relationship AND does promote smart, patient-centered, evidence-based, innovative & cost-effective care;
    EHR = Enterprise (and community of care-wide) intelligently annotated key lists as Problem / Medication / Intervention / Complication……lists;
    HIE = Health Information Exchange with county-wide, multi-county-wide, state-wide, region-wide, nation-wide and very secure local, state, national, international distribution of health information that promotes life, liberty and the pursuit of happiness
    CDS = intelligent Clinical Decision Support
    PDS = Patient-centered Decision Support
    CES = Multi-site Comparative Effectiveness Study capabilities that promotes cost-effective CQI (Continuous Quality Improvement)
    OMS – Outcomes Management System that promotes fair & cost-effective, clinical / financial outcomes
    NFCA = No-fault Complication Adjudication that obviates the need for tort system involvement in most all “malpractice” decisions and awards comparable (but better) to (than) the systems in place within Sweden and New Zealand;

    5) TRUE TAX REFORM that eliminates waste, fraud and abuse in USA taxation systems with FAIR & JUST distribution of a percentage of reform’s savings for subsidization of the above so the goal of Fair / Universal / Just access to cost-effective health care services is achieved for ALL AND is sustainably achieved.

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