EDITORIAL: Thursday More needs to be done to corral medical costs

Oct. 12--The fatal flaw of the Affordable Care Act is that it never adequately dealt with the high cost of health care in the U.S.

There is no reason that health care in the U.S. should be twice the cost of other developed nations.

For instance, Americans spent $9,980 on health care in 2015 vs. $4,640 for Canadians, according to the Organization for Economic Cooperation and Development.

Obamacare dealt with access first and put off cost controls for later.

Now Republicans have fallen into a different trap with plans that will cut access in order to reduce cost. No wonder their plans have been so unpopular. A Washington Post-ABC News poll showed Americans prefer Obamacare to Cassidy-Graham by 56 percent to 33 percent.

So why isn't cost being addressed? Well, one person's high cost is another's profit.

And billions are spent lobbying Congress to protect high costs/profits.

Republicans also fell into the trap of Hillarycare by doing too much of their health care planning in secret.

As reported by the Columbia Journalism Review, the Trump administration took the secrecy established during former President Barack Obama's administration to a new low.

At least the Affordable Care Act went through the regular legislative process.

One way to deal with costs is to put more focus on those few patients with multiple conditions.

Just 1 percent of patients account for 20 percent of costs, reports The New York Times. Just 5 percent of patients account for nearly 50 percent of the nation's health spending.

Digging down, many of these high-cost patients have chronic illnesses and limitations such as difficulty walking, using transportation and feeding themselves.

These patients are three times as likely to be hospitalized, and that means high costs. Often there is a co-existing mental illness.

There are 12 million of them, such as:

--Veterans with disabilities.

--Grandparents with Alzheimer's.

--Young women with lupus.

More than 80 percent of these patients get their health care through Medicare or Medicaid.

That is why the expansion of Medicaid has the potential to restrain cost growth. What these people need is outstanding primary care.

And they can benefit from a different payment scheme than fee for service in which more services means more cost and more revenue for providers.

Value-based payments give providers a stake in keeping patients out of emergency rooms.

The Times reported on CareMore Health of California, which spends twice as much on primary care prevention and disease management than traditional Medicare but only half as much overall.

Companies with on-site clinics can often better manage the health of employees by reminding them of appointments, tracking health indicators and providing free or low-cost prevention services.

PRICE SHOPPING

About 60 percent of health spending involves elective, outpatient care, wrote Scott Atlas in The Wall Street Journal. Shopping for price and quality ought to be easier.

By using health savings accounts with high-deductible plans, consumers have a monetary incentive to save.

spending CAP NEEDED

One feature of the Republican bill that is an overall cap on spending. This infuriates Democrats, but it is essential to finally rein in costs.

Health industry expert Robert Laszewski wrote for CNBC that the single-payer plans that Democrats love overseas have cost caps.

That may seem like a blunt instrument, but every program needs a budget. Only the government acts like money grows on trees.

PRESCRIPTIONS

The high cost of prescription drugs has become a scandal with generics skyrocketing in cost, with patents adjusted in order to avoid a generic while some lifesaving medication is out of reach.

Since price controls are anathema to many Americans, then competition needs to be used to control prices. And The New York Times has offered these suggested fixes for high prescription costs:

--Allow access to cheaper drugs from other developed nations.

--Let the government negotiate the price of Medicare-covered drugs.

--Speed up approval of generic drugs.

--Limit patents for pills that modify medication with little added benefit.

--Adjust prices according to drug effectiveness.

GROUPS ARE SPEAKING UP

Health industry groups have stepped up to voice their concerns about Republican repeal and replace plans.

Who can disagree with this joint statement by the groups: "While we sometimes disagree on important issues in health care, we are in total agreement that Americans deserve a stable health care market that provides access to high-quality care and affordable coverage for all."

The Jimmy Kimmel test is worth repeating: "No family should be denied medical care, emergency or otherwise, because they can't afford it."

WAIVERS

In reality, Republicans could take the waiver process that's already included in Obamacare, expand it and allow states to craft plans that fit their cultures.

After all, Hawaii, Illinois and Massachusetts -- three states where Obama has lived -- have vastly different cultures.

As The New York Times noted, West Virginia has an opioid epidemic while heart disease and obesity are major issues in Mississippi. Large and varied states like Florida have major regional differences.

One state should take up an idea that's been proposed by Jacksonville's Carolyn McClanahan to use Medicaid funds to establish more federal health clinics.

The physician and financial consultant would do away with much of the administrative burden of Medicaid in favor of more convenient primary care.

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