Goal:
Reintroduce competition into health insurance, medical providers, pharmaceuticals, and intermediaries to:
- Lower real healthcare costs for all Americans.
- Reduce government spending on healthcare programs by cutting costs.
- Foster innovation.
- Return healthcare decision-making to doctors and patients.
- Emphasize prevention.
Current Problems:
- 80/20 Rule for Insurance Profit Caps
- This rule incentivizes insurers to increase premiums, as their profits grow proportionally.
- Health Insurance Marketplace
- Instead of lowering costs and expanding benefits as intended, the marketplace facilitates collusion among insurers, leading to increased premiums and reduced benefits.
- Patent Abuse
- Pharmaceutical companies extend patents excessively, stifling competition and maintaining monopoly pricing. Reform is needed to allow broader compounding and competition.
- Monopoly Pricing Across Healthcare
- A disconnect between pricing and consumer awareness enables collusion and inflated pricing throughout the system.
- Pharmacy Benefit Managers (PBMs)
- PBMs often collude with insurers, providers, and pharmaceutical companies, contributing to hidden costs and monopolistic practices. Independent audits are necessary to ensure competitive pricing and prevent kickbacks.
- Transparency of Costs
- Current disclosures are too complex and lengthy for most consumers to understand. Simplified, accessible cost breakdowns are required.
- Open Enrollment Period
- The limited enrollment period benefits insurance companies while restricting consumer choice.
- In-Network vs. Out-of-Network Coverage
- Insurance networks give insurers control over patient care, provider incentives, and pricing, which undermines trust in doctors’ recommendations.
- Medical Billing Practices
- Inflated and arbitrary billing practices, coupled with frequent coding changes, increase administrative complexity and costs. Insurers exploit these processes to deny legitimate claims.
Proposed Solutions:
- Promote Direct Care Models
- Raise awareness about direct care providers operating outside of traditional insurance to encourage competition and pressure insurers to adapt.
- Pre-Existing Conditions
- Require all insurers to cover pre-existing conditions. A free market alone cannot handle the risk distribution fairly.
- Transparent and Comprehensive Pricing
- Facilities must provide upfront total costs for care, including all providers involved. Average costs, including potential complications, should be factored into pricing.
- Patent Reform
- Eliminate excessive patent extensions for drugs and medical technologies to foster competition and lower prices.
- Remove Profit Caps on Insurers
- Eliminate the 80/20 rule but ensure competitive pressures prevent excessive profiteering.
- Eliminate the Healthcare Marketplace
- Remove the centralized marketplace to foster more organic competition among insurers.
- End Open Enrollment Restrictions
- Let insurers set their own timelines for accepting new customers, allowing consumers to switch plans at any time.
- Ban In-Network/Out-of-Network Distinctions
- All licensed providers should be accessible to insured patients without penalties, ensuring fair competition among providers and reducing insurer control.
- State-Managed Healthcare for Low-Income Individuals
- Empower states to design tailored healthcare programs, reducing bureaucracy and inefficiencies in federal programs.
- Expand Health Savings Accounts (HSAs)
- Allow contributions regardless of insurance status and broaden eligible expenses to give consumers more control over healthcare spending.
- Reform Medical Billing
- Shift billing responsibility to facilities, requiring them to present the total cost to consumers and insurers. Disallow medical billing practices tied to insurance companies or outsourced contractors, creating competitive pressure for transparency and efficiency.
- Standalone Catastrophic Coverage
- Permit individuals in all states to purchase catastrophic health insurance without bundling it with comprehensive plans, allowing more affordable options for those seeking basic financial protection.
Conclusion:
By addressing monopolistic practices, improving transparency, and empowering consumers and providers, this plan seeks to reduce healthcare costs, increase innovation, and give patients and doctors greater control over care decisions.