When I first took a glance at businessman Andrew Yang, I immediately dismissed him as a hyper-leftist. He supported Medicare-for-All, the most radical healthcare plan being proposed by some of the Democratic candidates. But like others in the field, Yang has walked back his support for Medicare-for-All. His newly released healthcare plan is by far the most moderate being proposed by anyone polling over nil. It’s more moderate than Pete Buttigieg’s Medicare For All Who Wants It. It’s more moderate than Joe Biden’s Obamacare 2.0. In fact, it’s the only plan that, if proposed by Democrats and Republicans together, would likely pass with massive bipartisan support if one component was stripped from it.
Don’t get me wrong. I’m not a Yang supporter. I have issues with other policies he’s proposing and would actually enjoy a conversation with him over a couple that make very little sense to me. But I can say this about the candidate’s proposals: He’s the only one in the field who could appeal to right-leaning Independents and moderate Republicans in the general election. Polls say that person is either Biden or Buttigieg, but here’s the catch: When people start taking a closer look at the policy proposals they’ve backed themselves into in an attempt to appease the far-left in their party, those policies won’t hold up to scrutiny. They are to the left of President Obama and candidate Hillary Clinton. They’re much further to the left than anything this country has ever seen in the White House.
Biden and Buttigieg only seem moderate because the scale has been so skewed by the Democratic Socialist wing that extreme views seem tame compared to the radicals. Yang, on the other hand, has as his branded position the “Freedom Dividend,” a concept that has been examined by many conservative economists. Milton Friedman proposed a variation of universal basic income in the form of negative tax rates. Others have said it could work if cuts were made to other avenues of spending. A current Republican lawmaker recently told me off the record that if it could be used to reduce the need for welfare, it could actually work well.
What Yang unveiled today as “A New Way Forward” for healthcare in America is a six-point plan that makes sense. I’d strongly recommend Representative Kevin McCarthy and Senator Mitch McConnell give it a serious look.
Here are the bullet points to his six ideas with my commentary below.
1. Control Prescription Drug Cost
- Work with Congress to pass a laws to negotiate drug prices.
- Use international reference pricing to set a baseline and allow for forced licensing of medications if companies can’t come to a reasonable agreement with the federal government on cost in line with international prices.
- Create public manufacturing facilities to produce generic drugs (and produce drugs through a forced license) to keep costs at a minimum.
- Also manufacture unprofitable medications and important high-demand medications.
- If all of the above fail, allow for the importation of prescription drugs from other countries.
The last two ideas are great. There’s a great risk with the others, at least in a vacuum, because healthcare innovation is driven by profits. This is good and bad, but Yang’s proposal doesn’t address either. It’s good that pharmaceutical research is profit-driven because it allows for the generation of more funds that private companies can reinvest into more breakthroughs. The bad part is it puts an emphasis on treatments over cures. Treatments are profitable as they’re ongoing. Cures are inherently not profitable.
To truly address the prescription drug issue, incentives need to be established that take advantage of American ingenuity and resources while keeping DC’s hands out of it. There have been a handful of proposals I’ve read over the years that would drive innovation while also guiding it towards cures and prevention rather than super-profitable ongoing treatments.
2. Invest in Innovative Technology
- Encourage the use of telehealth in rural areas and for mental health services.
- Invest into the use of telehealth in rural areas including ensuring broadband access for 99.9% of Americans.
- Allow licensed physicians to administer medical services and medication through telehealth services.
- Invest in the development and deployment of medical technology in rural areas to assist Nurse Practitioners and other professionals in administering vital care in areas where an MD is not physically present.
- Implement federal regulations over telehealth.
- Implement federal medical licensing to physicians to practice telehealth across state lines.
These are no-brainers. The only nitpicking I could do would be to take out the broadband access component. It tastes too much like recently proposed “Internet for All” schemes that suggest spending huge infrastructure dollars to provide digital access to people who simply don’t want it. Nobody moves to the boonies in Montana with the expectation of streaming Netflix. They did so for a reason. Those who have intense medical needs won’t be hours from the nearest town. It’s a pointless addition to the plan. Otherwise, spot-on.
Conservatives may be scared of the idea of federal regulations and licensing. But the plan does not call for the elimination of state medical requirements and licencing. As long as he allows states to regulate their doctors as they see fit but allows for separate telehealth-only licensing and regulations, it passes the federalism smell-test.
3. Improve the Economics of Healthcare
- Work with clinics and hospitals to increase the use of salary-based compensation for doctors.
- Explore capitation payment options for health providers and utilize the use of electronic records to track success.
- Discourage doctors from practicing defensive medicine by making them less vulnerable to frivolous malpractice lawsuits and providing institutional support to doctors, resulting in an increase in time spent with patients.
- Direct the complete overhaul of the Electronic Health Record with an emphasis on modernization and ease of use.
- Incentivize innovation in EHR by opening up vendors to include third-party developers and explore standardizing APIs across EHRs.
- Lift the regulations and funding caps that currently limit medical residents and other health professionals from entering the medical field.
- Provide loan forgiveness programs for doctors who go into general practice, especially in rural areas.
- Work to expand medical schools that focus on primary care.
There’s a whole lot to unpack here. Capitation and salary plans can work on a small scale but have never been tested on larger scales. There are many risks, especially if it will be the federal government implementing these changes. We’re talking about an ideal system in the long-term that could suffer cataclysm on the road to getting there. It’s conspicuous that he uses the words “work with” and “explore” in the first two bullet points instead of “mandate” and “implement.” Such a move could be great if steady hands over a period of time longer than a president can be in the Oval Office were handling it. That’s a lot to ask of DC, but the spirit of the plan is acceptable.
Frivolous malpractice suits – yep. No objections to protecting doctors in this regard.
Fix EHR – yep. The system is flawed without any good reason other than nobody has addressed it.
There are several slippery slopes in the last three bullet points. He’s describing getting further involved in the way states handle healthcare for their residents. It’s a populist concept that would need to be handled carefully. His last two bullet points would shift the job market tremendously. It would raise the costs of hiring specialists because of higher demand and could cause an imbalance of too many primary care physicians. Such programs would have to be limited and adjusted on the fly as needed.
4. Shift Focus of Care
- Encourage doctors to educate their patients about the importance of diet, nutrition, and physical activity on overall health.
- Incentivize integrated preventative care and healthy activities, like gym memberships, biking to work, and consuming fresh produce.
- Offer incentives for food banks and clinics to partner together to promote food accessibility and reduce health disparity.
- Encourage providers to have direct and honest conversations about end-of-life planning.
- Allow for patients and families to be more involved in decisions around end-of-life care.
- Respect a patient’s decision to choose home care, even when it won’t extend their life.
- Take into account quality of life instead of just length of life for terminal patients.
- Ensure that there are enough doctors educated about end-of-life and palliative care to provide effective treatment rather than acute medicine.
The first bullet point isn’t policy, nor should it be. Doctors will do as doctors will do and I’ve never met one who didn’t tell me to eat better and exercise.
I’d want to learn more about the incentives he proposes in the second bullet point. It seems like a nothingburger (or nothingpomegranate, if you prefer) that could eventually lead back to Michelle Obama’s school meal decadence plan.
More funding for food banks is good. Better management of charities to feed the needy would be better.
As for the end-of-life proposals, yes, we’re at a stage in society when all of these ideas make sense. We are better at keeping people alive than we are at maintaining an acceptable quality-of-life. As long as he doesn’t get into assisted suicide, these are all positive changes.
5. Coverage Should Include All Aspects Of Wellbeing
- Integrate regular mental health checkups into primary care.
- Provide new funds for suicide prevention and awareness competency training for school administrators and teachers, and provide greater access to mental health services in schools.
- Build the mental health workforce through expansion of training programs and loan forgiveness programs for those that choose to provide these services to rural and underprivileged areas.
- Invest in veteran mental health, and improve funding to crisis helplines.
- Utilize the current telehealth system to alleviate the widespread shortage of mental healthcare professionals, remove accessibility barriers caused by distance and transportation, and provide treatment from the privacy of patients’ homes.
- Ensure that hospitals are ADA compliant.
- Make healthcare more accessible to people with disabilities through telehealth, while also ensuring public transit to facilities is accessible and covered by insurance.
- Ensure healthcare covers preventative care services for people with disabilities like assistive mobility devices, hearing aids, adequate catheters, and sufficient physical therapy visits to prevent further secondary conditions.
- Ensure that all families have access to experts and resources for early detection, intervention, and care for children with disabilities.
- Bring down the cost of HIV/AIDS treatment through international reference pricing and public manufacturing facilities, if necessary.
- Cover HIV/AIDS treatment.
- Break the patent on TRUVADA to provide low-cost PrEP to anyone who might be at risk.
- Provide funding for clinics like Planned Parenthood that can screen for HIV/AIDS, especially in rural areas.
- Ensure Americans have access to comprehensive sexual and reproductive care, including STI screenings, contraception, and abortion.
- Ensure contraceptives and medication abortion pills can be accessed over the counter.
- Ensure access to non-discriminatory healthcare, like gender-affirming services.
- Protect funding to Planned Parenthood by repealing the Title X Gag Rule.
- Repeal the Hyde Amendment, and refuse to sign any budget including it.
- Allocate more resources to maternal health research.
- Fully cover all maternity costs.
- Invest in implicit bias training for healthcare providers to ensure Black women receive life-saving maternal care.
- Establish objective treatment guidelines for childbirth care to mitigate pregnancy-related deaths.
- Ensure comprehensive care includes vision and dental services.
- Explore ways to reduce the burden of healthcare on employers, including by giving employees the option to enroll in Medicare for All instead of an employer-provided healthcare plan.
The first seven bullet points on mental health and disabilities are good.
Breaking the TRUVADA patent is dangerous only because it sets a precedent. Yes, it’s important, but the last thing we need is for pharmaceutical companies to pull back the reins on treatments or prevention options because they believe they’re going to lose profits when the government decrees their patents are void.
Then, there’s the abortion component. Remember when I said above that one component would have to be stripped? This is it. Yang needed to include it if he has any chance of winning the nomination, but it’s a non-starter for millions of Americans, including me.
Covering maternity costs is another populist view that would require a full cost analysis to see if it’s even possible.
Including vision and dental should not be mandated. There’s already a vibrant and affordable market for coverage. This isn’t solving a problem. It just mandates convenience at unnecessary expense. It won’t save anyone money and could end up costing more as the prices associated are hidden.
Selling a public option as reducing burden on employers is smart. I don’t agree with it as the burden would be transferred to taxpayers, but since Republicans seem to no longer be in the business of repealing Obamacare, this really wouldn’t be much of a change from the status quo.
6. Addressing the Influence of Lobbyists
- Refuse to hire anyone in my administration who formerly worked as an executive in the pharmaceutical industry or as a lobbyist for pharmaceuticals, medical devices, or private insurers.
- Provide an Anti-Corruption Stipend for all members of the Executive Branch after the termination of their employment, to be paid as long as they don’t accept anything of value in exchange for advocating for a position to members of the federal government.
- Provide every American voter with $100 Democracy Dollars for each election cycle to protect their representatives from medical lobbyists.
- Increase salaries for government officials who regulated the medical bodies to much higher levels, but ban them from receiving anything of value in exchange for currying favor for special interests.
So, the $100 Democracy Dollars incentive is odd, but only because I probably don’t understand how it works. Call me obtuse. Everything else in his portion of his plan makes sense and should be extended outside of healthcare.
Lawmakers on both sides of the aisle should take a look at Andrew Yang’s plan. It’s the only healthcare proposal from a Democrat that isn’t ludicrous. Considering what Capitol Hill has done with healthcare (nothing), this is worth a peek.
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