Issue Position: Health Care

Issue Position

5 Steps to Reduce Healthcare Costs

1. Implement the Healthcare Compact to give states flexibility
Healthcare is too important and too intimate for a one-size-fits-all mediocre federal solution. The federal government was never given this authority in the constitution to force states hands in such business. Congress should take up and pass the Health Care Compact that I sponsored and passed in Missouri (HB 423). Since I sponsored this bill in Missouri in January of 2011, this compact has passed in Missouri, Georgia, Oklahoma, Texas, Utah, and Indiana. It gives each member state the flexibility to regulate all of the healthcare laws of their own state. What works for citizens of Texas doesn't work for the citizens of Missouri. By allowing each state to experiment we can see what provides the best solutions at a price the taxpayers can afford in each respective state. To learn more about the Healthcare Compact go to www.healthcarecompact.org

2. Make health insurance personal and portable
Very few people purchase health insurance like they do car insurance. Most health insurance is purchased through the employer because of tax incentives. This trend began as a result of wage controls during World War II. Because employers could not increase salaries, they competed for employees by adding perquisites. Then in 1953 the IRS ruled that employer expenses for health insurance were not part of wage compensation for tax purposes. Which means if an employee is paid a $30,000 salary and $16,000 in health insurance premiums then the employee is not taxed on the $16,000. The problem is that this savings is not provided to people if they purchase insurance outside of their employer. If the same tax benefits were provided outside of the employer then employees would make market decisions on their own. They would be able to purchase the health insurance that best suits their needs. And most importantly when insurance companies take advantage of their customers, the customers would have the ability to take their money to a better insurance company.

3. Increase competition amongst insurance companies
By giving patients the power to pick their insurance companies the results will be reduced prices and better insurance. Currently you can purchase automobile insurance across state lines. As a result, while health insurance premiums have drastically risen over the past decades auto insurance premiums have remained static. By allowing people to purchase insurance across state lines consumers would have thousands of choices in insurance as opposed to the handful of choices that operate in Missouri.

4. Reduce insurance and hospital mandates
If you were going to purchase a pizza but you couldn't just purchase a cheese pizza or a pepperoni pizza, but instead had to purchase a pizza with 50 toppings you would suddenly have a very expensive pizza that you wouldn't necessarily want to purchase. Sounds crazy, but that is exactly what we do with health insurance. Every health care suppliers lobby to maker their products or services required to be included in insurance plans and every year politicians add mandates to health insurance, mandating that consumers purchase things that they may not necessarily need or want. By removing insurance mandates we can return insurance to a system where the customer/patient gets to choose what they want and what they can afford as opposed to forcing everyone to purchase a product that few can afford.
Mandates on hospitals also drive up costs. When we pay for service at a hospital like CoxHealth or St. John's our rates are increased because of the underpayments of the non-insured people and who use Medicaid (MO Healthnet). Currently Medicaid only pays about 12 cents for every $1 of care. Because government passes on unfunded mandates to hospitals when a person pays for health insurance they are paying a hidden tax in their premiums because the government is shifting the costs back through the hospital and insurance companies by not picking up the tab. People like to argue that healthcare is a right and that "free-riding," or uncompensated care, as if they were unavoidable laws of physics, like gravity. But it's not. In fact, this problem is a direct result of a clumsy, unfunded mandate. In 1986 congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA). EMTALA requires that hospitals provide emergency care to anyone who needs it, regardless of citizenship, legal status (i.e. illegal immigrants), or ability to pay. It also means that hospitals cannot turn away people who are not in an emergency. There are many healthcare issues that can and should be handled at a clinic, or urgent care. Hospitals should be able to inform patients of the costs differences and direct patients to the appropriate level of care for the situation.

5. Increase the supply of medical professionals
It isn't just the insurance industry that needs more choices and more competition. Patients/consumers should also have more choices of healthcare providers. For decades medical schools have not increased their graduation numbers, despite the long list of applicants willing to pay an arm and a leg to go to medical school. Why do universities turn down good applicants and the money they are willing to pay? Because of the pressure from alumni to keep graduation rates down. The reason is that providers don't want to compete with other doctors graduating from school. There have been drastic unintended consequences. To meet the growing medical demands and the physician shortages hospitals are hiring physicians from all over the world. In addition the healthcare industry has seen an opportunity to use mid-level providers to meet the growing demand. Nurse practitioners, Physicians Assistants, Nurse Anesthetists, Midwives, Chiropractors, and other non-physician medical professionals are stepping up to meet the needs of the growing medical communities. Universities need to graduate more doctors. We need to increase the capacity at University of Missouri School of Medicine. We also need to make sure that the scope of practices in medicine are there to protect patients and not just to protect the competitive turf of one medical profession from another medical profession.

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