Hot takes from health leaders: Overrated and underrated policy solutions for high healthcare costs
Healthcare affordability won’t be solved by people who all think alike. It won’t be solved by staying in our ideological corners, repeating the same arguments, or waiting for someone else to act.
It will be solved by leaders willing to speak honestly and directly, even when it’s uncomfortable.
That’s the spirit behind Hot takes from health leaders: a biweekly series featuring candid responses from the policymakers, clinicians, hospital executives, researchers, and advocates who will convene at LOWN26: Confronting Healthcare Affordability on May 21st in Cambridge, MA.
Because before we can find common ground, we need to know where everyone actually stands.
New installments published every two weeks leading up to LOWN26. Join the conversation on May 21st—register now.
Register before prices increase!
The healthcare affordability crisis isn’t a partisan issue. It’s a human one. This one-day conference brings together leaders who recognize that solutions won’t come from staying in our corners.
Past questions have included:
- What can a young clinician can do about affordability?
- What keeps you up at night?
- Who needs to fix the affordability crisis?
- Where is healthcare getting it right?
This week’s question: What’s an overrated policy solution for fixing high costs? What should get more attention instead?
Increasing bureaucracy vs. the quality of care
The belief that adding more bureaucracy to Medicaid—through tighter eligibility rules, additional administrative layers, or increasingly complex oversight—in order to reduce costs for consumers or overall system spending is, in my view, overrated. In many cases, these strategies create barriers that lead patients to delay care, which ultimately drives higher downstream costs for the health care system.
Too often, policy debates focus on incremental fixes onto a structure that was never designed for affordability or simplicity. Imagine the costs associated with billing, prior authorization, eligibility verification, contracting, and navigating multiple payers. This friction adds cost without adding better outcomes. Safety-Net health systems experience this most acutely. The real opportunity lies in simplifying how care is delivered and paid for, by aligning incentives, minimizing unnecessary barriers, supporting coordinated care, and allowing safety-net systems to focus resources where they have the greatest impact: improving health outcomes and advancing quality of care.
If I could wave my magic wand, I’d say we need to build a new system, that’s the policy solution we need. We are wasting a lot of time and money on patching up a system that people are fighting about whether it even works.
Donna Lynne, DrPH, Chief Executive Officer, Denver Health
Staff reductions vs. nurse minimums
States have enacted policies requiring that hospitals create committees to provide guidance on nurse staffing levels; unfortunately these policies leave a tremendous gray area for implementation and accountability. The only evidence-backed solution shown to improve patient safety, reduce burnout, and save costs for hospitals and payers is hospital minimum nurse staffing requirements.
Successfully implemented in California and Oregon, these policies hold hospitals accountable to staff enough nurses in hospital units at ratio levels (i.e., 4 patients per 1 nurse in medical-surgical units) so that patients receive the best care possible. Over two decades of evidence demonstrates that safe hospital nurse staffing ratios are associated with reductions in avoidable hospital readmissions, shorter hospital stays, and lower rates of nurse burnout, further reducing healthcare costs.
K. Jane Muir, PhD, MSHP, RN, Assistant Professor of Nursing, University of Pennsylvania School of Nursing
Loss ratios vs. monopoly breakups
Adjusting Medical Loss Ratio (MLR) in an effort to limit carrier profitability is overrated because burgeoning vertical integration has resulted in giant conglomerates in which gamesmanship among sister organizations and divisions is routine.
What should get more attention are federal policies to break up these giant healthcare conglomerates as they are the root cause of high costs. Breaking them up would result in less opportunity for gamesmanship and increased competition. This along with greater cash price transparency, quality transparency, and banning of physician non-competes are a package of policies that could level the playing field yielding lower healthcare costs.
Gloria Sachdev, PharmD, Secretary of Health and Family Service, State of Indiana
Price transparency vs. equitable coverage
Overrated:
1. Price transparency. Hospitals have a hard time producing helpful data and consumers have a harder time interpreting it. I do not oppose the idea, but do not think it is the answer to high costs. It can be effective for some elective procedures but that is not driving the high cost of health care.
2. Overreliance on market forces to drive down costs. We have been trying that for decades and it has not worked. Markets ration goods according to the ability to pay. I do not believe that is what most in our country want for health care.
More attention:
1. (easier) Enact laws or more strictly enforce existing antitrust laws to deal with private equity and other for-profit ventures aiming to consolidate market power for the purpose of driving profits.
2. (harder) Public option or some other model of universal coverage. With broad coverage based on societal rules and publicly defined responsibilities and benefits, we will have more opportunities to manage costs better.
Fred Cerise, MD, MPH, President and Chief Executive Officer, Parkland Health
Transparency. Given how difficult it is for trained actuaries to balance the cost/benefit equations even with mega data sources, it’s hard to imagine that “transparency” can enable this for more casual users of healthcare. Instead, we should eliminate the profiteering intermediaries who have profoundly misaligned incentives.
Ed Weisbart, MD, National Board Secretary, Physicians for a National Health Program
Value-based pricing vs. equitable access
The focus on utilization through value-based pricing policies as a tool to lower costs has been overrated as it creates tradeoffs with equitable access. Instead, public power should be harnessed to ensure coverage of services and treatments that are truly beneficial for patients through stronger regulation.
Reshma Ramachandran, MD, MPP, MHS, Assistant Professor, Yale School of Medicine
For-profit insurers vs. community health centers
For-profit insurers managing public insurance, e.g. Medicare Advantage and Medicaid plans (are overrated). Community health workers and the community health approach deserves more attention.
Andrew Goldstein, MD, MPH, Assistant Professor, Department of Medicine at NYU Grossman School of Medicine
Patchwork coverage vs. single payer
We already have a system that can provide emergency health care, health maintenance and screening, maternal care, school physicals, and many many more (services). Everyone living here would benefit from a system that provides this care to whomever needs it. It is called Medicare for All—a single payer healthcare system funded by the government.
Susan Rogers, MD, Physicians for a National Health Program