By NextBestFitTaxpayers and public budgets
Everyone who funds public programs, and the budgets that pay for them.
Under your mix of paths
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Problems that hurt them
Paths that fix these help them.
- Medicare Advantage overpayments and coding intensity: Aggressive diagnosis coding raises payments to private Medicare plans.
- U.S. prices are far higher than in other countries: Public programs pay more than peer countries too.
- Facility fees: the same service costs more in a hospital-owned building: Hospital ownership adds a facility fee to the cost of the same clinic visit.
- Executive pay and nonprofit status: Tax exemptions for hospital systems forgo public revenue.
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- Patent thickets and evergreening delay generics: Extended monopolies keep them paying monopoly prices longer.
- About $1 trillion a year in administrative cost: Public programs pay for it too.
- Low-value care and overtreatment: They pay for tests and treatments with little benefit.
- Fraud and improper payments: Fraud and improper payments consume public funds and premiums.
- Hospice growth, for-profit entry, and fraud: Hospice fraud concerns threaten public spending.
- One payer becomes one target: A single national payer concentrates fraud and cyber risk.
- Covering long-term care can pull unpaid family care into the paid system: Replacing unpaid family care with paid aides increases public costs.
- Covering all residents raises cost and migration concerns: Covering undocumented immigrants adds public cost.
- Raises spending or loosens control over it: Public budgets pay the added spending.
Problems they gain from
Paths that fix these cost them.
- Tens of millions of people have no coverage: Public budgets avoid subsidy costs in the short run.
- People lose coverage when their life changes (churn): Budgets save money when eligible people fall off.
- Immigrants and mixed-status families fall through gaps: Coverage exclusions limit public spending in the short term.
- U.S. territories get capped, lower federal health funding: Capped territorial funding limits federal spending in the short term.
- Chronic underfunding by government budgets: Restrained health funding limits public spending in the short run.
- Under-investment in equipment and facilities: Restrained capital investment limits spending in the short term.
- Slower access to new drugs and technology: Strict value assessment lowers payment for new products in the short run.
- Central coverage decisions can feel like rationing: Declining low-value care holds down public spending.
- Fixed budgets can ration care: Global budgets cap spending.
- Price limits can cause shortages, launch delays, or exits: Low price limits reduce spending in the short term.