A Policy Prescription for 2016

Since the founding of Policy Prescriptions®, I have written an essay on the most important health policy decisions for the year ahead. Last year I suggested a few compromises upon which might be wiling to agree. Despite a lack of action on this, 2015 saw one major policy priority, the elimination of the SGR formula, .

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Now, with a presidential election and the make up of Congress potentially in flux, 2016 promises another opportunity for making improvements to our fractured health care system.

Five major issues will dominate the debate en route to the elections in November. Below, I hope to frame these issues, provide a recommended course of action, and establish a means by which to judge candidates who adhere to the principles of my Policy Prescription for 2016.

1. Drug Prices

Several national polls and popular press reports indicate that the general public is fed up with the rise in drug prices and the apparent price gouging of a few bad actors in the pharmaceutical industry. While some might try to justify the high price tag of new treatments to cure hepatitis (which is largely responsible for the >12% annual increase in drug costs), there is almost no way to explain 5000% price increases on some existing drugs other than as pure profiteering.

One of the most effective and rational ways to instantaneously bring down drug costs in the U.S. would be to with pharmaceutical companies. It would bring a savings of up to $16 billion.

Unfortunately, the Republican led Congress that passed the explicitly made a policy decision that banned the Medicare program from leveraging its nearly 50 million members to extract lower pharmaceutical costs. Reversing course would not be unprecedented, and is within reach since candidates are seriously considering this policy option.

2. Consumer Insurance Issues

The ACA has provided a means to insurance coverage for millions of Americans, and although it doesn’t go far enough in terms of , it is certainly better than the 2009 status quo. However, as coverage gains have occurred, the rational next place to turn is the adequacy of the coverage provided.

Many healthcare consumers are upset with the narrow networks, large deductibles, and high out of pocket costs that result from low cost insurance products in the ACA Marketplaces. Unfortunately, there are no clear evidence-based solutions for these issues other than saying: “well at least you now have coverage.”

Consumers’ health insurance issues promise to be an important campaign issue in 2016 and I would expect to see solutions from several candidates. I fear that some will simply say to deregulate the ACA Marketplaces or to purchase insurance across state lines. However, and would likely lead to skimpier insurance coverage.

Consumers want cheap insurance; patients want comprehensive coverage. But until consumers and patients (who happen to be the same thing in this instance) can balance their disparate wishes, the high price tag for healthcare is likely to continue.

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