“I want a proposal that delivers true freedom”: Policy experts debate affordability solutions at LOWN26
The recording below is from a panel at LOWN26: Confronting Healthcare Affordability. All panel recordings are available on Youtube.
As working families face impossible choices between care and financial survival, finding common ground isn’t a thought experiment. It’s a moral imperative. At our LOWN26 kickoff panel, policy experts from across the ideological spectrum brought their viewpoints to the table. Watch the video recording and see some key quotes from the panelists:
- Erin C. Fuse Brown, JD, Professor of Health Services, Policy & Practice, Brown University School of Public Health (Moderator)
- Michael F. Cannon, Director of Health Policy Studies, Cato Institute
- Adam Gaffney, MD, Assistant Professor of Medicine, Harvard Medical School; Past-President, Physicians for a National Health Program
- Hayden Rooke-Ley, JD, Senior Fellow, Brown University School of Public Health
- Avik Roy, MD, Co-Founder and Chairman, Foundation for Research on Equal Opportunity
Affordability for patients
What do we mean when we say we need “affordable health care”? Affordable for taxpayers and society more generally, or affordable for patients and household budgets? Clearly we need solutions that improve affordability on all fronts.
To start the conversation, moderator Erin Fuse Brown asked panelists to give their take on how their proposed solutions would improve affordability for patients and households.
“People with good, employer-based insurance are spending the equivalent of a new Subaru Outback every year on coverage for a family of four. And for that they’re getting still unaffordable, unusable care.”
Erin Fuse Brown, LOWN26 Conference
Michael Cannon of the Cato Institute argued that putting more power into the hands of individuals through free market mechanisms would improve affordability.
“The reason that healthcare is so unaffordable, is because we’ve left too many of these decisions to the political process rather than to individuals, entrepreneurs, and market competition.”
Michael Cannon, LOWN26 Conference
Cannon and Avik Roy pushed for more patient choice in their insurance plans through ICHRAs (Individual Coverage Health Reimbursement Arrangements), and decoupling health insurance from employment. In this model, employers would pass along the tax break to employees, who could then shop for their own preferred health insurance.
“Everything that has gone wrong in American healthcare can can be tied back to the decision to eliminate from taxation the value of employer-sponsored insurance.”
Avik Roy, LOWN26 Conference
Adam Gaffney pushed back on the idea that more choice of health plans would improve affordability. “People in my opinion are not that interested in freedom of choice of health insurance. What they care about is freedom of choice of provider to go to the doctor they want, to go to the hospital that they want, to receive the medications that they need,” he said.
“I want a proposal that delivers true freedom, which is freedom of choice of provider.”
Adam Gaffney, LOWN26 Conference
Rather than only rely on market competition, we should create more incentives to harness the power of cooperation, said Gaffney. “In the heights of the COVID pandemic, we were cooperating across Boston, trying to move patients to where they could best be served…I would like to foreground that sort of cooperation among providers rather than market competition,” he said.
Affordability for society
How do we ensure that policies to improve affordability for households are also sustainable for government budgets?
Adam Gaffney pointed to single payer financing as a way to cut excessive administrative costs. With no private insurance companies, you can eliminate a significant source of administrative waste. “About one third of every U.S. healthcare dollar goes to administration. That’s about twice the share in Canada,” he said.
Avik Roy pointed to other countries like Switzerland that cover everyone through privately-run insurance companies, as a more practical method of universal coverage.
“If you’re actually looking for interesting ways to improve American healthcare, I would urge everyone to have a broader lens…You’ll find that single payer is not the only way to achieve universal coverage.”
Avik Roy, LOWN26 Conference
Hayden Rooke-Ley proposed utilizing more regulatory tools around ownership and governance to align the incentives of healthcare institutions with patients’ needs. That includes policies like standardizing prices and negotiating prices for new drugs and technologies.
“How do we build the sort of power within our health care system that empowers mass democracy?”
Hayden Rooke-Ley, LOWN26 Conference
Finding common ground
Although panelists came to the table with very different perspectives, they still agreed on several points:
- Universal health coverage is critical
- The employer sponsored commercial insurance market is not working
- Consolidation is creating market failures and increasing prices
- Regulatory capture of health institutions is preventing reform
Yet we have our work cut out for us when it comes to implementing the systemic changes that are needed to address these issues.
“I think where we disagree is with how easy it to implement those sorts of reforms. To get any reform through, it’s got to make it through, two chambers of Congress and then the other end of Pennsylvania Avenue and it’s got to clear the hurdle of the judicial branch as well,” said Cannon.