All across the nation, Americans are already struggling to pay their healthcare premiums — thanks entirely to Republicans cutting off the Obamacare subsidies that were making healthcare plans affordable for so many people. For nearly a decade now, Donald Trump has been promising to replace the ACA with … something. Something better. He’s never known exactly what it would be, other than “better,” but it would be better, and people would love it and then they would love him.
Well, at the end of last week, he finally revealed … The Great Healthcare Plan. The greatest thing about it so far? It is only about 350 words long, saving all of us the valuable time it would take to read an actually comprehensive and well thought out healthcare plan. So there’s that!
On the other hand, even if it were implemented by Congress, it would not actually do all that much to save Americans money on their health care costs — certainly not as much as the subsidies were saving them.
But let’s take a look anyway, shall we?
Via Whitehouse.Gov:
LOWERING DRUG PRICES
The Great Healthcare Plan calls for codifying the Trump Administration’s Most-Favored-Nation deals to get Americans the same low prices for prescription drugs that people in other countries pay. This would build off President Trump’s landmark actions that made insulin more affordable in his first term and the successful voluntary negotiations following his recent Executive Order to lower drug prices. Voluntarily negotiated deals with HHS/CMS will be grandfathered in.
The Great Healthcare Plan makes more verified safe pharmaceutical drugs available for over-the-counter purchase. This will lower healthcare costs and increase consumer choice by strengthening price transparency, increasing competition, and reducing the need for costly and time-consuming doctor’s visits.
First of all, we cannot negotiate prices the way other countries negotiate prices, even if we call ourselves the “Most-Favored-Nation.” Our system is not set up to do that.
We can negotiate prices to some degree, but US consumers cannot get the low prices that people in other countries get. Why? Well, for one thing, other countries function as one big insurance group, which gives them more leverage. For another, consumers in other countries actually get the negotiated price, while in our case, pharmacy benefit managers (PBMs) and insurance companies take their share as well and drive up prices that way. The FTC under President Biden discovered that PBMs were sometimes marking up generic drugs by well over 1000 percent.
Via Plan Sponsor Council of America:
The FTC used the “National Average Drug Acquisition Cost” (NADAC) to assess markups amounts. The NADAC is calculated based on surveys provided to Medicare and Medicaid, “primarily by small, independent pharmacies,” which tend to pay higher prices than large conglomerates. This methodology can lead to markups being underestimated.
Using this method, the report found that “Among the specialty generic drugs dispensed by PBM-affiliated pharmacies for commercial health plan members, 22 percent (10 out of the 46 drugs in our sample during this period) were marked up more than 1,000 percent, with 50 percent of these marked up more than 2,000 percent, while 41 percent (19 drugs) were marked up between 100 and 1,000 percent.”
Gleevec, used to treat cancer, was marked up 5232% in commercial markets and the drug Adcirca, used to treat pulmonary hypertension, from “an average of $27 in 2022” to “$2,106, on average, for a 30-day supply of the medication on commercial claims—an average markup of over 7,700 percent.”
Not great! You know, except for the Americans who “love their health insurance companies” and throw conniption fits over the idea of getting rid of them.
Beyond all of this, it’s worth noting that the 16 drug companies with whom Trump struck agreements to lower prices have actually raised their prices this year. According to an analysis by drug price research firm 46brooklyn, these companies raised the prices of 872 brand-name drugs within the first two weeks of January.
There were 18 major price cuts — four of which were tied to the Medicare price negotiations in President Joe Biden’s Inflation Reduction Act.
Next up …
Lowering insurance premiums
The Great Healthcare Plan stops sending big insurance companies billions in extra taxpayer-funded subsidy payments and instead send that money directly to eligible Americans to allow them to buy the health insurance of their choice.
The Great Healthcare Plan funds a cost-sharing reduction program for healthcare plans which would save taxpayers at least $36 billion and reduce the most common Obamacare plan premiums by over 10% according to the Congressional Budget Office.
The Great Healthcare Plan will end the kickbacks paid by pharmacy benefit managers (PBMs) to the large brokerage middlemen that deceptively raise the cost of health insurance.
Clearly, a 10 percent reduction in cost is not going to do jack shit for people whose insurance premiums more-than-doubled on average (some increases were much much much higher) at the beginning of this year. Additionally, while giving money directly to consumers is a popular idea within Republican circles … if it’s not specified that this money must only be used on ACA-compliant plans, it could result in people buying off-market plans that are often cheaper but don’t necessarily include the same protections. Like, for instance, covering pre-existing conditions. The more people you have buying these plans, the more difficult it will be to sustain that provision for everyone else.
As mentioned, PBMs literally are middlemen. They are the ones that get rebates and discounts from pharmaceutical companies, distribution fees, price reductions from the 340B Drug Pricing Program, etc., and then don’t pass them on (or at least not all of them on) to you the consumer. There are, of course, lots of middlemen in private insurance and the only way to cut them all out is to get rid of private insurance entirely. Because if one middleman isn’t taking that money, another one will.
Holding Big Insurance Companies Accountable
The Great Healthcare Plan creates the “Plain English Insurance” Standard by requiring health insurance companies to publish rate and coverage comparisons upfront on their websites in plain English—not industry jargon—so consumers can make better insurance purchasing decisions.
The Great Healthcare Plan will require health insurance companies to publish the percentage of their revenues that are paid out to claims versus overhead costs and profits on their websites.
The Great Healthcare Plan will require health insurance companies to publish the percentage of insurance claims they reject and average wait times for routine care on their websites.
This is fine, I guess, but a huge part of the problem with our current system is that people are required to do such an absolutely insane amount of research in order to choose a healthcare plan. It’s absolutely dizzying and frustrating. People shouldn’t have to look at price lists for 87,000 different plans and compare them to the monthly premium and the deductible to “find the best plan” for them. It’s a stupid way of doing things.
Maximize price transparency
The Great Healthcare Plan requires any healthcare provider or insurer who accepts Medicare or Medicaid to prominently post their pricing and fees in their place of business.
There are different prices for different insurance groups and plans, not one uniform pricing for all. That is why, in 2021, the Biden administration started requiring healthcare providers to provide that information and required insurance companies to do so starting in 2022. Which is to say … this already exists, but good try on taking credit for it.
What we must reject, however, is the premise that comparison shopping is the thing that is going to save us money with something like health care. It’s not exactly helpful in an emergency situation, now is it? If one is bleeding out in an ambulance, it’s hardly the time to ask for the different prices at different hospitals in order to decide where to go (and this is literally something I have seen people suggest as a possibility). It’s not always helpful to choose one’s health insurance based on one’s current needs, because that is something that can change in the blink of an eye.
Indeed, having so many different rates for everything is an enormous part of why healthcare costs so much to begin with. Because people have to be paid to negotiate those different rates, people have to be paid to negotiate whether or not something is going to be covered, people have to be paid to send different bills out to different insurance companies. If it were all the same, if it were all going to the same place, that would save a hell of a lot of time and money. Money that could instead be used … for actual health care.
This is not great. It’s not health care. It’s not a plan. It’s 350 words that mean practically nothing whatsoever. It will not save anyone money, nor is it even meant to. It’s only purpose, really — other than giving Trump something to point to when he says he has a health care plan — is to cement the idea in people’s minds that what they want is a health care plan tailored to them and their specific needs, and that comparison shopping is the thing that will really save them money — when, in fact, these are the things that actually cost us money in the end.
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www.wonkette.com (Article Sourced Website)
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