If you could change one thing about how American health care is structured, what would it be? [View all]

https://www.notus.org/perspectives/if-you-could-change-one-thing-about-how-american-health-care-is-structured-what-would-it-be







Americans’ health would benefit from a return to evidence-based vaccine policy. Putting aside the immediate crisis we face, there are common-sense steps we could take to build on the undeniable health and economic benefits that vaccines deliver. It’s time to pair the Vaccines for Children (VFC) program, which provides vaccines at no cost to children whose families might not otherwise be able to afford them, with a long-envisioned Vaccines for Adults (VFA) program. These programs should be independent of Centers for Disease Control and Prevention recommendations, meaning any American who wants access to a Food and Drug Administration-approved vaccine to protect their health could have it, regardless of their ability to pay. According to CDC data, over the last roughly 30 years, VFC has helped avert 508 million lifetime cases of illness, 32 million hospitalizations and more than 1.1 million premature deaths. It also generated more than half a trillion dollars in net savings. Estimates suggest VFA could provide a 19-fold return on investment, increasing productivity and reducing health care costs. VFA and a further strengthened VFC would empower individuals and doctors, putting the decision to vaccinate in their hands. Unfettered access to vaccines will increase uptake, save lives and avoid unnecessary health care costs.

Michael Osterholm is the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.




In my years working at The Washington Post, we were all acolytes of the Woodward and Bernstein mantra: Follow the money. It’s no different in health care. And that’s why we need to put an end to fee-for-service medicine. Under the current U.S. system, we pay (and pay and pay) for people to do things to us. Write a script, draw blood, scan an image — ka-ching, ka-ching, ka-ching. It’s a perverse set of financial incentives. If your friendly neighborhood doctor, nurse, lab tech or surgeon doesn’t do something, they don’t get paid. And if that happens often enough, they can’t pay their rent, buy groceries or pay for the kids’ dance lessons. They aren’t greedy, and it isn’t their fault; it’s the economic paradigm that forces them to behave this way. One perverse incentive leads to another. So simple fixes are escalated to the ER, because that’s a higher fee. Why run one test if three are available? Overuse of services, by the way, is not only costly but dangerous. Rarely does someone in the health sector get paid to keep you out of the hospital, off the meds and living life to the fullest. Needless to say, inevitably most of us will need some of those things done. But wouldn’t it be nice if the incentives were flipped?

Ceci Connolly is president and CEO of the Alliance of Community Health Plans.




Every health reform debate over the course of our history — expanding coverage, addressing costs, fixing payment systems — has been constrained by a fundamental flaw: We still treat health care as a privilege, not a guarantee. As long as eligibility for coverage depends on where (or whether) you work, how much you earn, where you live, or whether you’ve filled out the right paperwork, millions will cycle in and out of care. Eligibility redeterminations for Medicaid coverage, work requirements and narrow benefit designs reflect a system built to ration access and address fraud (real or perceived) but not to promote health. If we recognized health care as a right — a basic guarantee of dignity and opportunity — it would mean continuous, affordable access to primary and preventive care, not just for those who qualify or can afford it, but for everyone. It would allow states and payers to focus on improving quality and outcomes rather than creating and enforcing eligibility hurdles. Recognizing health care as a right doesn’t require a single payer or one-size-fits-all model. But it would mean a national commitment that every person can access affordable care without fear of bankruptcy. That foundation would enable other reforms and results: care coordination, smarter spending and a healthier, more productive country. If we really want to “make America healthy again,” it starts with guaranteeing that health care is assured, not earned.

Liz Fowler is a distinguished scholar at the Johns Hopkins Bloomberg School of Public Health.




Nearly one-quarter of Americans with private health insurance get an extra break on their health spending by holding a tax-favored savings account, generally a Health Savings Account or Flexible Spending Account. These tax breaks are inequitable and inefficient, and their knock-on effects inhibit the effective functioning of a competitive health care market. Get rid of them! Benefits from savings accounts are greatest for people in high marginal tax brackets who have ample funds to set aside for future expenses. They do nothing to make care more affordable for most Americans. These breaks turn the logic of insurance design — encouraging people to be deliberate in the initiation of care while protecting them against high expenses — upside down. Instead of protecting people from high costs, they offer discounts on the first dollar of care and for entirely discretionary purchases such as eyeglasses, vitamins, and, most recently, fancy treadmills and Oura Rings. In doing so, they drive up insurance premiums. Finally, these accounts subsidize the provision of medical services outside insurance networks. Because plans representing millions of members are far more effective negotiators than individuals, subsidizing that care undermines price discipline across the market.

Sherry Glied is a professor at, and former dean of, New York University’s Robert F. Wagner Graduate School of Public Service.

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