Thank you for your thoughtful and well-considered work. I agree with most of the things that you say here. For example, it does not make sense to me to add another generation of people between 55 and 63 to medicare, when it is bankrupt already. It doesn't make any sense to take away money from medicare, which can't cover the costs now nor reimburse providers in a sustainable manner in order to give coverage (likely equally broke) to millions more people. I also support medicare advantage programs as they provide a choice in many areas of the country that would not have adequate services for the elderly otherwise. If we took people's money with a promise that we would provide a decent program to pay for medical care in the future, then we need to make good on the promise. That includes the medicare "gap" that is not covered in the budget for the current. We need to be honest with our seniors, our medical care providers, and with America's taxpayers as well.
For Medicare Part D, the so-called donut hole, can we not provide a program similar to flexible spending accounts that will help people meet those expenses without penalizing them by treating it like an asset or taxing it like a benefit? This should be something people could fund while they are still working.
I also agree that we should import less expensive drugs. The argument that they are not safe is silly. The drugs we make here aren't safe either, as a large number of recalls, law suits and faulty research results have shown over the last decades.
What I am not convinced about is that the quality of care needs to be improved. From what I read and hear about, the US quality of medical care is envied throughout the world. It is equitable distribution that is the beef. However, this is not a socialist or communist country. I don't know how we can get away from the "you get what you pay for" aspect of this. That aspect is also what drives innovation, cost savings and provides a marketplace for new professionals, businesses and industries. It is hard to be better when everything has to be the same for all.
Finally, I have not been able to find how the proposals address the following issues that directly affect the cost of medical care - and isn't that the point of this whole exercise anyway?
1) Medical malpractice - which I call the malpractice lottery. We need to face the fact that a lot of lawyers are making themselves very rich off the backs of medical care providers and it isn't improving care for patients one whit. It leads to defensive medicine and very conservative approaches which result in more costs, less innovation and do not improve the quality of care or improve outcomes. It is now about the survival of the business, not the patient.
2) Consumer involvement in comparing cost and value of specific services, not just insurance policies. Until consumers are active participants in questioning the cost and necessity of medical care through incentives such as tax free medical savings accounts, this is just more gaming between the government, insurance companies and big providers like Humana.
3) Since the current administration feels it is entitled to set salary and compensation limits for other subsidized industries, let's tackle this issue too. It is disgusting that non-profit hospitals are paying their administrative people "top 5%" salaries, while physicians and nurses are continually being asked to give more for less. Likewise, the way that medical insurance plans are funded and details on where the money goes needs to be transparent and clear to consumers. For example, to participate in CFC, we require charities to reveal their administrative and lobbying costs versus direct benefits. We should require the same for hospitals, mega corps like Kaiser and Humana and for insurance companies as well.
4) It needs to be a lot more transparent who is in the tank with whom. I no longer believe any of the so-called spokespersons looking out for me. Not the AMA, AARP, AFSCME, NEA, AFT and especially the AFL/CIO. And I certainly have my doubts about Congress. I want to know where the money goes before I believe anyone. In the current climate, motive is everything and facts are scarce. How much medical care could we buy for the billions the industry spends lobbying? I feel we need to cut off that particular industry on this particular issue and only Congress can do it.
My thinking on the subject.
Best wishes to you, your staff and family for a safe holiday season.