A new health care reform plan titled “Choices for All,” published by the Hoover Institution at Stanford University, recommends several key changes to federal programs.
Authors Lanhee Chen, Tom Church, and Daniel Heil, suggest Congress include a new type of tax-advantaged savings account; expand tax deductibility to include out-of-pocket medical expenses; increase flexibility for state innovation waivers which could allow the Affordable Care Act (ACA) exchanges to offer a greater variety of plans; roll back rules limiting association health plans; and enable the creation of more plans participating in direct primary care programs.
The authors say the problem with health care today is “missing prices,” writing, “…centralized healthcare suffers from the same issues as all other centralized economic activity: it distorts prices so that they no longer convey useful information about value or cost. In the process, it takes choices away from patients and limits them to government-approved coverage.”
Republican candidates and officeholders who want to reform health care have many proposals to choose from, and the Hoover proposal builds on previous policy plans while providing some new wrinkles.
Concerns About Costs, Access
Americans are concerned about health care costs and access, says Merrill Matthews Jr., Ph.D., a resident scholar at the Institute for Policy Innovation.
“With some 28 million people still uninsured—remember, Obamacare was supposed to essentially eliminate the uninsured—and millions of Americans losing their pandemic-related, expanded Medicaid coverage, and with the cost of health insurance skyrocketing, health care is likely to be a major topic of discussion in 2024,” Matthews said (see related article).
“Democrats will want to spend more on government-run health care,” Matthews said. “Republicans need an alternative, and the Hoover plan provides a very wide-ranging discussion of the existing problems with a number of reasonable options that build on the current system.”
Calls for Price Transparency
There is much to like about the Hoover plan, but it should be refined further before being used in 2024 election campaigns, says Devon Herrick, a policy advisor to The Heartland Institute, which publishes Health Care News, and a contributor to the Goodman Institute’s Health Care Blog.
“Rather than create a new individual health account, why not just reform health savings accounts?” said Herrick. “Allowing states more flexibility to create health plans that meet consumers’ needs is a good idea.”
Herrick says he likes the plan’s proposal to expand scope of practice to allow patients to see a wider variety of providers.
“Expanding residency programs to train more physicians is a good idea, as is making it easier for foreign-trained doctors to practice in the United States,” said Herrick. “Ending certificate of need laws that block competition is a good idea. Allowing Americans to deduct medical expenses would put individual insurance on a level playing field with employer insurance.”
Hospitals Forming Regional Cartels
What the Hoover plan is missing is a tangible way to boost price transparency and price competition, says Herrick.
“Hospitals are consolidating into regional cartels,” said Herrick. “They are snapping up physician practices and boosting costs by claiming services are now provided through the hospital.”
Herrick says “perverse incentives” are driving out competition.
“Increasingly, patients are afraid to see a doctor because they can’t ascertain prices in advance and they’re afraid of being ambushed from bills they didn’t expect,” said Herrick.
Lots of Ideas
There are many plans for Republicans to choose from, says Roger Stark, M.D., a health care policy analyst at the Washington Policy Center, retired physician, and policy advisor to The Heartland Institute.
“Hoover’s plan is one of several that Republicans and conservative think tanks are promoting, and Grace-Marie Turner of the Gallen Institute recently published a list,” said Stark.
“There is a consistent vision in the new Choices for All Project, the Consensus Group’s Health Care Choices proposal, FREOPP’s Fair Care Act, the Goodman Institute/Rep. Pete Session’s Health Care Fairness for All Act, the Heartland Institute’s American Health Care Plan, countless ideas from the American Enterprise Institute, Heritage, Paragon Health Institute, and many state-based think tanks, in addition to the dozens of individual bills making their way through the legislative process in Congress,” said Stark.
All of these plans attempt to give patients more choices while working within the existing health care framework, says Stark.
Stark Contrasts to Obamacare
The Hoover plan introduces incremental changes that potentially could pass in a bipartisan fashion and gives Republicans health care talking points to counter the Left’s single-payer proposals, says Stark.
“As we have discussed before, the fundamental problem with health care in the United States is that almost 90 percent of care is paid for by a third party, either employers since 1943 or the government since 1965,” said Stark.
“Until patients can control their own health care dollars and make their own care decisions, costs will continue to escalate and choices will be limited,” said Stark. “Repealing the ACA would have helped, but Medicare and Medicaid are not viable in the long term and must be reformed. Unfortunately, no politician who wants to be elected can advocate for a complete overhaul of our health care system.”
Kenneth Artz (email@example.com) writes from Tyler, Texas.
Lanhee Chen, Tom Church, and Daniel Heil, “Choices for All,” Hoover Institution, July 2023: