by Robert Gnaizda & Elaine Soliven
THIS week (September 9), president obama will address Congresson the need for a controversial health care reform package that maynot achieve his objectives. our message to the president is that thevast majority of American communities are underserved by presenthealth care practices and insurance coverage. Many of these communitiessupported president obama’s election and initially supported his health care reforms.
Many now have concerns that the president’s “heroic” efforts tobring to America what Europe has had for two to four generations may not occur without debilitating compromises that we may all regret.
We have no doubt that health care reform is immediately necessary.However, we are dubious that it will occur in a fashion that willbe satisfactory to the 47 million Americans who are uninsured, the50 million Americans who are underinsured and 300 million Americanswho are contributing close to $2.4 trillion a year for one of theworld’s most inefficient health care systems among developed nations.
From Main Street, we offer to the president and the leaders ofCongress eight practical and possibly bi-partisan suggestions thatwould have the overwhelming support of Americans, even if they opposeuniversal health care coverage. They are likely to sail throughCongress or be implemented by the president without Congressionalassistance by July 4th of next year.
A key suggestion is dump the “sweetheart deal” with the pharmaceuticalindustry. its support for the ill-fated health care reformbill is not worth the price. We can save $1 to $2 trillion over thenext ten years primarily by a series of presidential executive ordersand actions that require no Congressional approval. The easiest actionwould be for the president to use his bully pulpit and executivepowers to demand that the pharmaceutical industry provide to allAmericans prescription drugs at the lowest price offered in any developednation, such as Canada, Great Britain or France. This wouldcut present drug costs from $236 billion annually to below $120 billionsince most prescription drugs sell for one-third or one-half theUS price in other developed countries. over ten years, this wouldproduce a savings up to $1.2 trillion. This is fifteen times more thanthe projected savings from the $80 billion “sweetheart deal.”
Similarly, the president should use his executive powers to convincehis newly-appointed chairs of the FTC and his anti-trust divisionchief to exercise America’s often underused anti-trust powersagainst the pharmaceutical industry during mergers and acquisitions.For example, half or more of many pharmaceutical companiesso-called “research and development” is used for other activities,such as enticing university researchers and physicians into promotingtheir products. The proposed pfizer/Wyeth, and Warner Chilcott/p&G acquisitions would be good places to start.
To further lower health care costs, the president should seek a bipartisanbill, likely to be supported by the highly influential Republican Senator Grassley, that would eliminate the $13 billion a year indirect federal tax subsidies to so-called nonprofit hospital that fail tocare for the poor. A recent study shows that 60 percent of the averageso-called “nonprofit” hospitals with tax subsidies offer less than5 percent of their patients free or low cost service. Many of the mostexpensive problems for the uninsured could be addressed withoutcost if hospitals were required to provide 20 percent of their servicesto indigents in order to be tax exempt.
A fundamental problem in cutting health care costs, which are often twice as expensive in the US as in Canada or Europe, is caused by“fee-for service” physicians who control most of the delivery of our$2.4 trillion health care system. Health care costs could be substantiallyreduced if doctors were on salary, as are virtually all of our 2.9million nurses and as are physicians at many health insurers such as Kaiser permanente. Doctors on a “fee for service” basis should be aluxury, not the standard for 21st century cost efficient practices.
Another major reform that is long overdue is empowering America’s2.9 million nurses, particularly those with advanced training,to perform a wide range of medical services that are now part of anoften unnecessary physician monopoly. This should be a conditionfor any federal funding and is likely to slash physician costs by 25 to50 percent and increase the quality of services.
There are many other cost-cutting devices that the president coulddevelop a bi-partisan consensus on. For example, expenditures fornonprofit health care clinics and a major preventive effort to cut obesityby 50 percent which alone could save over $750 billion over thenext decade since in 90 percent of the cases obesity is preventable.
Robert Gnaizda is a former California Director of Health and Counsel for the Black EconomicCouncil.
Elaine Soliven is the President of the San Diego Filipino American Nurses Association of SanDiego County, Inc. a part of a national network of 180, 000 Filipino American nurses