Lower the cost of health care? Here’s what Missouri Influencers have to say

Aug. 13--The Star asked the Missouri Influencer panel to respond to readers who said their biggest healthcare issue is lowering the cost of health care and making it accessible for all, including those with pre-existing conditions. The question for the Influencers: What can policymakers do?

Mark Bedell, Kansas City Public Schools superintendent: "Policy makers have to continue to push the conversation at the federal level from both sides of the fence."

John Hancock, political consultant, former Missouri GOP chairman: "Tort reform, removal of coverage mandates to allow the purchase of catastrophic coverage, encouragement of HSAs."

Patrick Tuohey, Show-Me Institute director of municipal policy: "The best way to maintain quality while reducing cost is to allow as much free market competition as possible -- including transparent pricing. This itself is not sufficient, but it is a necessary first step to addressing other important concerns such coverage for as pre-existing conditions."

Jay Nixon, former governor: "Begin in a much more robust fashion the use of technology to get better outcomes and lower costs. Much of technology in healthcare is simply focused on billing."

Patrick Ishmael, director of government accountability for The Show-Me Institute: "Short-term medical insurance offers patients an opportunity for coverage at a fraction of the price of Obamacare plans. The tradeoff consumers should be mindful of is that those savings are achieved by offering fewer features. For those with pre-existing conditions, Obamacare plans will likely remain the preferred coverage option; but for a host of Americans priced out of those plans, including millions of young and healthy consumers, STM offers a real opportunity for savings and protection. Last year the Missouri House passed a bill that would have allowed STM coverage to have a duration of up to a year. (That bill was HB1685.) After federal rules were finalized August 1 to liberalize STM regulation, state action is still required to maximize the availability and impact of these more reasonably priced insurance options for Missourians."

David Steelman, attorney, member of University of Missouri Board of Curators, former legislator: "It is important to explicitly state that despite the 'easy' solutions proposed by people running ins elections, health care is enormously complex and there are no easy answers. Having said that, I do believe in competition and that eliminating or modifying the anti-trust exemption for insurers would be helpful. That exemption was intended to protect the rate making process and has been abused by health insurers agreeing to virtual monopolies along state lines. The only thing preventing policymakers from that change is courage."

Jack Danforth, former U.S. senator: "Policy makers must transform payment for healthcare from the current fee for service model to a pay for performance model. Currently, providers are reimbursed for procedures, which provides an incentive for doctors and hospitals to test more and do more with little regard for the efficacy of the procedure. This accounts for over treatment and exploding costs. The fundamental question should not be the number of procedures but the improvement of health."

CiCi Rojas, partner and president of Tico Productions LLC and Tico Sports: "Expand medicare to raise the poverty level income levels. Allowing small business to band together in cohorts to purchase group plans. It is cost prohibitive for many small businesses to offer group plans."

Crosby Kemper III, director of Kansas City Public Library, co-founder of Show-Me Institute: "National competition with a range of plans with great transparency as to cost and benefits. There should be higher subsidy based on income and age but no completely subsidized plans so there is some cost for all."

Woody Cozad, lobbyist and former Missouri GOP chairman: "Mostly, get out of the way. Everything the government says it will help us afford becomes unaffordable. The most expensive things in our lives are higher education, houses, and health care. The government has been 'helping us' pay for all three for about seventy-five years. Another twenty-five years of Washington's help and we'll all be bankrupt."

Gregg Keller, principal of Atlas Strategy Group: "With the individual mandate now gone, Obamacare isn't sustainable financially (if it ever was) so the worst thing we could do is prop up a failing scheme that robs Americans of health care options. I'm extremely hopeful about the president's focus on Association Health Plans (AHPs), which allow businesses and trade groups to begin their own health care cooperatives across states and pool their purchasing power."

James Harris, political strategist: "Roughly 33 percent of Missouri's budget goes towards Medicaid, so policymakers should definitely discuss the issue. The big issue is stemming the growth in healthcare costs. This is a complex issue that will require lawmakers to look at a number of different things, from misuse of emergency resources, to wasteful practices in the healthcare industry, to the increasing cost of lawsuits."

Jason Grill, media, public affairs and crisis communications consultant: "Policymakers can focus on preventative services and higher quality initial service and care, which would cut down on wasteful spending and higher costs down the road."

Quinton Lucas, Kansas City Council member: "On the local (and state) level, finally reaching adequate investment in mental health care services are key. This includes public funding for those not already using regular outpatient mental or other health services."

Pam Whiting, vice president for communications, Greater Kansas City Chamber of Commerce: "1. Both Kansas and Missouri should expand Medicaid to close the coverage gap, with adequate funding for health care providers serving the economically disadvantaged.

"2. Ensure coverage for those with pre-existing conditions.

"3. Allow Medicare to negotiate drug prices."

Thomas Curran, president of Rockhurst University: "Policy makers should focus upon the creation of legislation that provides incentives and awards for healthy living. Additionally, policy makers should discontinue the dismantling the Affordable Health Care Act."

Chris Maples, interim chancellor at Missouri University for Science & Technology: "I believe that policymakers can help lower the cost of health care and make it accessible for all by having policies that emulate those in the automobile insurance sector."

Kay Barnes, former mayor of Kansas City, senior director for university engagement at Park University: "Concerted efforts should be made to correct any deficiencies in the Affordable Care Act."

Richard Martin, director of government affairs for JE Dunn Construction, former political consultant: "Work with the federal government to expand Medicaid."

Michael Barrett, director, Missouri State Public Defender: "Policy goals should focus on making an investment in preventative care. One reason costs are so high, and access is limited, is because, for too many, care only becomes available once someone experiences an emergency or critical event. This yields not only high costs that are then redistributed but also poor results. Front end, preventative care for all should be the focus of investment. Savings will come by reduced cost on the back end."

Duke Dujakovich, president of Greater Kansas City AFL-CIO: "Policy makers need to find a solution that works for the state and not wait for the federal government to solve this."

Jeff Simon, managing partner, Husch Blackwell: "Healthcare must be aligned with free market economics in order to control cost. After all, what other goods or services does the consumer purchase without regard to cost, beyond perhaps a fixed co-pay or deductible? Policymakers should expand risk pools, define certain minimum coverage requirements, and require transparent pricing. If true market competition is introduced to the healthcare industry -- where the current biggest payors are health insurance companies and the government, not the actual consumer -- and backstops the most vulnerable with coverage, the cost challenges should begin to resolve themselves."

Mike Burke, lawyer and former member of the Kansas City Council: "Elected officials need to expand affordable health care, especially at the federal level. The politically inspired attacks on the Affordable Care Act do nothing to address health care for the average person. You don't hear 'repeal and replace' anymore, just the repeal effort. This is very shortsighted."

John Murphy, Shook Hardy & Bacon: "I believe there are several things we can consider. First, we should strive to provide patients with more information about the medical treatment they are seeking. The problem is that patients are not provided sufficient cost information by health care providers or insurers. I am not suggesting that cost be the determining factor but rather that costs should be provided along with information regarding effective outcomes so health care consumers can determine the best value.

"It may not be attainable but more competition among health care providers and insurers would likely lead to lower costs. Studies have shown that the trends toward consolidation of physician practices and the number of hospital mergers tend to keep health care costs high. Additional competitive bidding would likely lead to more reasonable costs and better quality.

"We also should consider tax incentives to companies that have wellness programs that work. It is undeniable that preventive care reduces overall health care costs.

"Another issue that must be addressed is waste in the health care industry. For example, data suggests that hundreds of millions of dollars' worth of medication is thrown away every year by nursing homes. Excess drugs that remain after a patient dies or a medication regimen is discontinued simply go to waste. In Iowa, the state funded a program to recover those nursing home medications and donate them for free to needy patients. Missouri should consider a similar program.

"There are countless other ways to reduce health care costs. We simply have to take an organized approach to the problem and look for solutions that are founded on good business practices."

Jennifer Lowry, chief toxicologist at Children's Mercy Hospital: "The impetus for the development and implementation for the Affordable Care Act was recognized and put forth because of the need for lowering the cost of health care and making it accessible to everyone. Unfortunately, this has not changed since it was passed due to changes that had been made during and since the debate. Policymakers should realize that health is not partisan. Discussions need to occur with stakeholders at the table who can make tough decisions that put people's health first and politics last. Recognizing that concessions will need to be made across the table, health and the financial burden of healthcare need to be the unwavering top priorities amidst the sacrifices required."

Dianne Lynch, president of Stephens College: "Cutting costs is hard work; just ask any Missourian who has had to choose between food, heat and medicine. But policymakers could take two straightforward steps that would be a giant leap toward affordable health care for all: Expansion of the Medicare Fee Schedule -- which caps reimbursement to doctors and hospitals -- to apply to all patient care, and regulation of U.S. drug prices to rates competitive with those in Canada or the UK. Unfortunately, that would mean our political leaders would need to say no to the $563 million the healthcare industry spent to influence lawmakers last year. And that may be the greatest challenge of all."

Ryan Silvey, Missouri Public Service commissioner, former state senator: "I don't think there is a single solution, but I do think more transparency in the market would be helpful. Under the current system, most people have no idea what the true cost of their healthcare is because most bills are circulated within the system itself and the consumer only becomes aware after the fact when they are presented with what's left. Being presented with comparative information up front would allow the consumer more control and ability to make decisions as we do in every other sector of the economy."

John Fierro, Kansas City Public Schools board member: "We need policymakers to find a balance between creating a competitive & financially profitable healthcare market for insurers and healthcare providers while embracing the reality of income inequality in our country; affordable healthcare isn't a benefit if you have to choose between healthcare and paying your rent, your utilities and/or provide your children with three balanced meals a day."

Alissia Canady, Kansas City Council member: "Support expansion of the affordable care act!"

Jean Paul Bradshaw, lawyer and former U.S. attorney: "Be honest with people that it is expensive to provide health care at the highest level, rather than lead people on that there is a simple solution. It is a complicated system and reform is not easy."

Jane Dueker, lawyer, radio host and former political adviser: "Expand Medicaid so that we reduce the number of uninsured citizens, which in turn reduces the cost of premiums for the insured population. Stop the attorney general from suing to allow insurance companies to deny coverage to people with pre-existing conditions."

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