Piecemeal solutions will not heal the system

Rising healthcare costs are again an issue biggest concern for voters in the 2024 elections. While members of both parties agree the costs are too high and discussed these challenges during the meeting presidential And vice presidential debates, the candidates have not been specific about their plans to address them.

Former President Trump was widely challenged proverb he had “concepts for a plan” to improve health care. That said, neither Trump nor Vice President Harris have outlined detailed proposals to address the fundamental challenges facing this country’s health care system, which will require systemic reforms. Despite different political approaches, both candidates’ policies focus on the symptoms of the healthcare crisis, such as drug pricing and insurance coverage, without addressing healthcare’s broken business model.

The healthcare system is failing not just because we invest heavily in it without getting commensurate value in return, but because the entire structure – how care is delivered, paid for and incentivized – is unsustainable.

The Harris-Walz proposal aims to expand government safety nets and introduce new regulations that are likely to further disrupt market dynamics. Harris is seeking to build on Biden-era legislation such as the American Rescue Plan Act and the Inflation Reduction Act, which extend ACA eligibility and subsidies through 2025. She also wants more price controls on pharmaceutical products. As I wrote in a recent column, Vice President Harris is seeking to expand key provisions of the Inflation Reduction Act beyond Medicare recipients. Her plan would expand the $35 monthly insulin limit and $2,000 annual limit on out-of-pocket drug costs currently available to seniors to all Americans.

While the Trump-Vance ticket is taking steps toward market-based reforms like price transparency, it ultimately falls short of addressing the deeper, structural problems within healthcare — offering, like their opponents, only band-aid solutions to a system that needs more fundamental solutions. change. During his first term, President Trump introduced price transparency requirements for healthcare providers, who sought to make healthcare prices more accessible and understandable to consumers. The healthcare segment successfully resisted these efforts even after the Supreme Court enforced the law. JD Vance emphasized the importance of this issue during the vice presidential debate, in which he said that in health care, “price transparency will actually give American consumers a little more choice, and also reduce costs.”

As president, Trump attempted to implement price controls, proposing to cap drug prices based on lower prices paid in other countries Most favored nation model. Although the plan was ultimately rejected by the courts, Trump’s campaign has not yet taken a final position on how he would address drug prices if he is elected to a second term. The price of pharmaceuticals appears to remain a dual concern, and as I have written elsewhere there will be a need for an integrated set of solutions, not recurring band-aids aimed at one segment of the market.

Ultimately, piecemeal solutions from either party will not deliver what the patient-consumer needs: better health outcomes at a lower total cost of care. Neither side is looking through a wide enough lens. As such, the proposed solutions fail to address the root causes.

Healthcare’s fundamental problems won’t be addressed at the margins – essentially tweaking regulations one time at a time without understanding how the parts fit together. CMS has been trying to bend the cost curve for more than 30 years without success; prices have continued to rise, while results have faltered and satisfaction has fallen. More integrated solutions – solutions that address concerns across the political spectrum – remain unexplored, leaving us with short-term solutions that have increased the complexity and costs of an overly complex, costly and opaque system.

As I have argued elsewhere, politicians on both sides of the aisle should focus on the underlying total costs of healthcare, including the costs of regulation, transparency and quality outcomes, rather than fixating strictly on the cost of prescription drug prices or insurance coverage in a vacuum. . Both are symptoms of a broader problem: a healthcare model fundamentally broken by misaligned incentives. Each solution serves as a distraction from solving the underlying problem.

In the current system, healthcare, payers (traditional insurers, employers and government), pharmaceutical companies, medical device companies and consumers – every part of the industry – are not incentivized to consider an innovative, market-based model , let alone embrace it. , in which payment is linked to outcomes that matter. But this is the model consumers need. If the next administration is committed to transforming the healthcare industry for the better, it must refocus incentives through cost and quality transparency, accountability for healthcare delivery across the continuum, and policies that encourage consumer/employer competition based on outcomes that matter.

Price transparency, which Trump and Vance have embraced, and Harris and Walz should support, is what allows patient-consumers to make informed decisions about their health care, just as they do in other parts of their lives. We expect to compare our options when we buy a new computer or sign up for a fitness class. We ask whether the product or service we are purchasing is worth the cost compared to competitors. Going forward, innovative organizations must build compelling, data-driven value stories that describe their services and answer the question, “Why should I go to ‘x’ for my healthcare services?”

If the goal is to make American health care more accessible and affordable, the next presidential ticket must implement a market-based reform model: transparency, accountability, and competition to achieve results that matter.