On Oct. 3, President Donald Trump issued an executive order on “protecting and improving Medicare for our nation’s seniors.” It’s only a statement of intent, but there’s quite a bit to like among the stated intentions.
Many have argued in the past that both Republicans and Democrats focus too heavily on the demand side of health care — specifically federal health insurance law. Both sides largely ignore the supply side — how care is actually delivered. This order, however, touches on both.
As Robert Graboyes, a senior research fellow at George Mason University, in Fairfax, Va., noted, “While the president’s executive order focuses on Medicare, it strikes a nice balance, giving full measure to addressing a broad collection of substantive supply-side issues.”
The single biggest challenge in American health care may be Medicare’s reimbursement methodology. The agency determines unilaterally which medical treatments are or are not worth reimbursing and then sets prices for thousands of services according to criteria that often have little to do with the value they deliver or the real costs of production.
Fortunately, the executive order seeks to devise “alternative payment methodologies that link payment to value, increase choice, and lower regulatory burdens imposed upon providers.”
But the really valuable parts of the order lie on the supply side.
These begin with a broadside against certificate-of-need laws, which restrict competition and supply in hospitals and serve virtually no useful purpose. The president’s statement also endorsed telehealth, a technology that can instantly bring quality care to anyone, anywhere, anytime.
The order strongly supports a broader scope of practice for non-physician providers and, perhaps, doctors as well, by opposing regulations “more stringent that applicable federal or state laws require and that limit professionals from practicing at the top of their profession.”
It also pledges support for reimbursing “primary and specialist health providers practicing in all types of health professions” and eliminating reimbursement policies detrimental to non-physician providers.
One of the great barriers to innovation in American health lies in the slow, costly, unpredictable process of gaining approval of new drugs and devices by the Food and Drug Administration. The order aims to streamline “the approval, coverage, and coding process” to get new treatments to patients more rapidly.
In addition to changes at FDA, this means narrowing the time between FDA approval and Medicare acceptance of FDA-approved products.
Finally, the order seeks to attack “waste, fraud and abuse.” Normally, that’s as meaningful a phrase as “let’s do lunch.” But the level of fraudulent Medicare claims is scandalous and a worthy target for reform.
For now, this isn’t law but merely words. If the words lead to actions, however, there may be good reasons to celebrate. And perhaps best of all, quite a few of the ideas have garnered bipartisan support at the state or federal level.