The Economics of US Health Care Policy by Phelps, Charles E. -- Read -- Imperial Library of Trantor

Index

Cover Half Title Title Page Copyright Page Dedication Table of Contents List of figures List of tables Foreword Preface Acknowledgments Executive summary Part I: The market for private health insurance

1 The pivotal role of employer-paid health insurance

Prologue and proposition How World War II still haunts us How the tax subsidy became permanent How the subsidy changed through time Why it matters: how the subsidy expands health insurance and health care use

2 An alternate universe: life without the tax subsidy

Employers would actively offer health insurance Robust markets would exist beyond the employer-based health insurance market Non-employer markets would actively use actuarial rating We might see fewer people with health insurance ... or perhaps not Job and entrepreneurship lock and insurance-related labor disputes would not exist The income tax system would not redistribute from the poor to the rich Summary of the “alternate universe”

3 How to get there from here and also grow the economy

Fix the tax law (Proposal 1) Previous efforts and ideas Further details about our proposal The macroeconomic benefits Summarizing the tax revenue effects Concluding comments

4 Who might support or oppose our proposal?

Who will likely oppose our proposal? What factors might generate support for our proposal? Some observations about horse trading

5 What else needs fixing?

Eliminate the employer mandate (Proposal 2) Eliminate the “precious metals” ranking system (Proposal 3) Fix the Health Insurance Exchanges (Proposal 4) Proposal 4a: franchise HIX to allow private operation of federal and state sites Proposal 4b: make health plan bidding dynamic Proposal 4c: allow and encourage national bidding and competition Proposal 4d: allow insurance sales across state lines Proposal 4e: passive, not active, management of the HIX market Proposal 4f: rationalize and solidify reinsurance mechanisms Summary

6 Pre-existing conditions and the individual mandate

Some observations about “experience rating” in insurance markets Different risk factors leading to pre-existing conditions The individual mandate Job lock and entrepreneurship lock It’s not about broccoli—it’s about free-riders

Part II: Medicare and Medicaid

7 Understanding Medicare and Medicaid

History and roots Some key changes in Medicare provider payment methods Changes in Medicare coverage options How Medicare decides what to pay for Medigap plans Some key changes in Medicaid structure Conclusion

8 Rationalizing Medicare and Medicaid

Ten specific proposals The combined effect

9 Further discussion of our Medicare and Medicaid proposals

Proposals 1 and 2: reset Parts A and B deductibles Proposal 3: set Medicare premiums to match regional cost differences Proposal 4: unshackle HDHP Medicare Advantage plans Proposal 5: require HDHP options with seeded MSA accounts for Medicaid enrollees Proposal 6: eliminate copayments for selected highly effective drugs and treatments Proposal 7: introduce and encourage consideration of costs in National Coverage Determinations (NCDs) Proposal 8: tax Medigap plans to account for extra cost burden imposed on Medicare Proposal 9: allow Medicare Advantage plans to offer different coverage options Proposal 10: experiment with new forms of physician compensation

Part III: Things that affect everybody

10 Chronic conditions

Millstones and their costs The “grey tsunami”—understanding age pyramids Combining pyramids and millstones The underlying causes of chronic conditions—a pathway to a solution How to treat chronic conditions How to reduce the frequency of chronic conditions Conclusions

11 Bringing health care waste, fraud, and abuse technology into the 21st century

The ideal system The task list

12 Towards a functional electronic health record—soon

The way we were ... and are Towards a better solution—today How far have we come? What stands in the way? Barriers to success A bridge to rapid deployment How does record sharing occur now? How would this happen in an EHR world? Who will become the trusted third parties? Incentives for individuals to participate Conclusion

13 Maximizing the promise of Accountable Care Organizations

Defining Accountable Care Organizations Beyond fantasy—making real the elusive risk-taking “unicorn” ACO Capturing the full value of the experiments

14 Getting rid of overstated medical bills 15 Concluding comments

Appendix to Chapter 3 Appendix to Chapter 5 Appendix to Chapter 6 Appendix to Chapter 9 Appendix to Chapter 11 Bibliography Index

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