Then-Candidate Donald Trump promised “better healthcare for less money” and said his administration would negotiate deals for the American people. But with Republican efforts to repeal and replace Obamacare stagnating, that seems elusive.
Yet there are winning policy strategies that can fulfill these promises. Here are four policies that won’t add to the deficit and could even attract some bipartisan support.
- Get more sensible payment terms from providers. Pioneered by the Bush Administration and continued through Obama’s tenure was a push for Medicare to pay higher rates to hospitals when the care is better. This is called “paying for value” by health policy wonks, and “old-fashioned common sense" by everyone else. A respected nonprofit called the National Quality Forum helped lay the groundwork by painstakingly achieving buy-in from interest groups on how to measure quality to calibrate payment. More effort around value-based payment is needed for MACRA, the recent bipartisan law reforming the way physicians get paid. Accelerate this work, and don’t lose momentum.
- Question payments for medical errors. Preventable accidents, injuries and infections are the third leading cause of death in America, killing nearly 700 people a day and wasting untold dollars. Here’s the kicker: Often the providers get paid more when these problems occur. According to calculations by my nonprofit, the Leapfrog Group, many employers pay upwards of $8,000 extra per admission for the wasteful cost of errors and infections. We released our updated Hospital Safety Grades last week, which assign a letter grade to over 2,600 general acute-care hospitals across the nation based on safety and quality. These grades show there remains a dramatic variation in hospitals’ overall performance in keeping patients safe from preventable harm and medical errors. It’s time to negotiate better terms to level the playing field.
- Grow health savings accounts. Ultimately, the best deal for an individual patient is personal preference, which can’t be negotiated by the government. But traditionally, few patients see themselves as active consumers whose preference counts. That is why back in the early 2000s Republican President George H.W. Bush successfully fought to shift some of the purchasing decisions to consumers directly, establishing tax-protected health savings accounts, which help consumers pay the extensive out-of-pocket costs associated with a high-deductible health plan. The principle: when consumers pay more out of their own pocket, instead of just a static copay, they stimulate a market that puts competitive pressure on pricing and quality.There’s a problem though. Individuals and their employers don’t always fund the savings accounts at high enough levels to adequately offset deductibles. Nonpaying customers do not create markets (and they don’t get great healthcare either); so Republicans might focus on policies that strengthen health savings accounts, for instance, by permanently exempting employer savings contributions from the taxes on health benefits planned under both Obamacare and the Ryan/Trump proposals.
- Expand transparency. Even families with excellent health coverage will find themselves bewildered when the time comes to find a doctor or hospital. It is still difficult to find good, reliable information to compare providers on price and quality. There have been inroads here too, but regulations could be lifted that hide important information the public deserves to know, such as the findings from accreditation reports and the prices charged. Any healthcare provider doing business with Medicare or Medicaid should commit to the highest levels of transparency.
Notice none of these policy ideas pivot on the issues that divide, like insurance pools, subsidies, tax credits or minimum benefits rules. Instead, they focus on making deals for better care at lower costs. That’s a job President Trump and leaders of both parties ought to accomplish now for the American people.