Health

The Ghost of Healthcare Past and Future

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This has been a banner year for changes to our healthcare. We began the year by trying to return to our pre COVID status, and it hasn’t been easy. The reduced funding and the return to the established Medicaid rules have proven to be difficult. Removing people from Medicaid eligibility impacts people, and it was exacerbated by the administrative problems each state had to overcome. This is an example of how difficult it is to withdraw a government benefit, even one that was instigated as a temporary emergency reaction to a pandemic.

This year implementation of the Inflation Reduction Act (IRA) that was passed in 2022 also began. The 2023 impacts on beneficiaries were:

  • A $35 cap on the monthly cost of insulin
  • Free vaccinations
  • An increase in Medicare’s services for behavioral health

While not affecting patient costs directly in 2023, the IRA has the power to demand that companies rebate to Medicare the amount of all drug price increases that exceed the rate of general inflation. I wonder what impact this will have on patient costs. Will the drug companies raise their initial price of a drug when it is first introduced? Will Medicare use the rebate to lower premiums? Will drug companies quit working on risky innovative cures because they won’t be reimbursed year over year? I always look out for the unintended consequences of changes to our healthcare system.

There have been a few silver linings to the pandemic, costly in lives and money but still a silver lining. The pandemic forced us to discover the best way to use telehealth, with the development of efficient procedures and equitable payment criteria authorized under the pandemic emergency procedures. Some of these emergency allowances were made permanent, including procedures concerning behavioral health and the ability for rural emergency hospitals to be the originator of a telehealth process. Other telehealth services were continued on a temporary basis, such as:

  • Being able to have telehealth services in your home
  • Not requiring an in-office visit within 6 months of a telehealth behavioral session
  • Allowing all Medicare eligible patients access to telehealth services
  • No geographical restrictions on telehealth originators

Another improvement to Medicare in 2023 was the elimination of the two-to-three-month delay for those who sign up for Medicare and also allowing people who have lost their eligibility for Medicaid to sign up during a special enrollment period.

Between the pandemic and the IRA, we have seen some immediate and long-term changes to Medicare. Some good, and some not so good.

As we gaze forward into 2024, the chances for more changes to our healthcare are extremely high. It’s a presidential election year and President Biden has already set the tone for more government oversight of our healthcare. When former President Trump voiced his plan to repeal and replace the Obama signature healthcare plan, the Affordable Care Act, President Biden accelerated his foray into changes to how healthcare is delivered in America. He will work to expand the number of drugs eligible for price controls under the IRA while expanding the price controls to the commercial (click here to read my blog predicting this would happen). He would like to make the enhanced federal premium subsidies that are scheduled to end after 2025 permanent. The Biden administration would like to see those states that haven’t embraced Medicaid expansion to get on the band wagon. While these proposed changes are certainly not insignificant, they are not the worst change that the President would like to make.

The idea of a single payer healthcare system, i.e., government-controlled healthcare, is not new by any stretch of the imagination. It has been talked about for decades, most recently during Biden’s 2020 presidential campaign, but it has been effectively squashed…until now. It is ominous for a sitting President to resurrect this discussion. To make the proposal more palatable, he has proposed that we just make the government-controlled healthcare an option to compete with commercial healthcare, another trick detailed in theblog referenced above. It doesn’t take a rocket scientist, or an economist, to see how this would go. The government healthcare option would be subsidized by government workers, paid for by tax dollars, and the whole program operated at a deficit in government terms, a loss in business terms. This artificial competition would soon force all the commercial providers out of business, at which point the government could set prices, ration services, and raise taxes to support the program. While I may be an alarmist, this all seems a logical progression to the point where the government is controlling every facet of our healthcare. An indication of the immediacy of this progression is a hearing scheduled for next month.

All the Democrats on the Senate Committee on Health, Education, Labor, and Pensions (HELP) have scheduled a hearing with some CEOs of major drug manufacturing companies on January 25, 2024, to discuss the high price of prescription drugs. Senator Bernie Sanders is the chairman of the committee and is orchestrating this partisan hearing. It seems that healthcare changes are on the top of the heap in this election year. I would be disingenuous if I didn’t point out that Senator Sanders is the leading champion of government-controlled healthcare. I’ll keep you advised as to the outcome of the January hearing.

Well, that’s where we’ve been and maybe where we’re going. I guess I haven’t painted a very positive picture of our future healthcare. To keep this blog in the spirit of the season (and to make sense of the blog’s title) maybe what I’ve described, like the ghost of Christmas past, are the problems in our healthcare past and then described the dire scenes of a healthcare future that could happen. The good news is that the ultimate message of A Christmas Carol is that the future doesn’t have to be that way, we can still have an impact on what will happen in 2024. We can make our feelings known by those that represent us in Washington. The need for us to speak out will be extremely important in 2024.

I hope you and yours have a great holiday with your families, see you in 2024. Best, Thair

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