Medicare and Medicaid are on the road to insolvency. There is no doubt about that among the numbers-crunchers; just among the politicians. It’s long been held that Social Security and Medicare are the “third rails” of politics – if you touch them, you’ll get burned. The recent uproar at the State of the Union address when President Biden falsely accused Republicans of wanting to get rid of these entitlements is just the latest in a long series of attempts to scare seniors into voting for Democrats.

But it is time that the adults in the room had a serious discussion about how to solve the insolvency problem. Seema Verma, former administrator for the Centers for Medicare and Medicaid Services under President Trump, offers her solutions in a recent article published in The Wall Street Journal.

Verma says the Medicare board of trustees has warned that the program is headed for insolvency in as little as six years. Medicaid has become the largest budget item in most states. Medicare and Medicaid collectively are two of the largest contributors to the national debt and will be the largest federal budget item by 2030, according to the Congressional Budget Office (CBO).

What are the solutions?

Verma says the answer to the current challenge doesn’t have to be rationing of care, higher taxes or increased costs for beneficiaries. Instead, she calls on the president to work with Congress to address the programs’ structural problems using common-sense market-based reforms. She believes doing so will help sustain important safety-net programs and improve the healthcare system for all Americans.

She believes the problem is fee-for-service medicine – the long-standing model for most healthcare in our country since health insurance was first introduced to the market. She says this model pays doctors and hospitals for the volume of service they perform with no regard to quality or outcomes. She calls for a change of the Medicare and Medicaid reimbursement schema by moving them toward a value-based reimbursement model. 

In value-based care, instead of getting paid only when a patient gets sick or for rendering a specific treatment, a doctor is prepaid a fixed amount based on the patient’s health status. This payment method is used to cover all the patient’s healthcare-related costs. The prepaid amount creates incentives for the provider to make investments in the type of care that avoids expensive emergency-room visits and hospital stays – at least according to Ms. Verma.

A value-based reimbursement model is another name for capitated payments. This type of reimbursement model has been around a long time since the implementation of managed care in the 1980s. It was first proposed then by large managed care systems as a way to save money. It may accomplish that goal, but at the expense of quality of care. Ms. Verma says this form of reimbursement “creates incentives for the provider to make investments in the type of care that avoids expensive emergency-room visits and hospital stays” – which sounds good on its surface.

But the real incentives this form of payment creates are for doctors and hospitals to withhold treatment. I’d like to believe that doctors will always do what’s in the best interests of the patient, and we usually do, but doctors are also humans and incentives matter. When the doctor can make just as much money writing a prescription or giving a shot as they can doing surgery, which one do you think will be chosen most of the time? To make matters worse, since more doctors than ever are now employed by hospitals, which form of treatment will their hospital-employers dictate their employee-doctors choose? You can be sure it will be the less-expensive treatments.

(For more on this subject, stay tuned for Part II of this series on my next blog.)

Vaccines are an important reason why life expectancy has made huge gains over the last century. That trend is threatened, however, by a growing skepticism about vaccines, especially for those on the political right.

As a physician, I am fully aware of the benefits and risks of vaccines and I fully endorse them for those who need them. That means I don’t endorse them for those who are not at risk. All medical decision-making weighs the risk-benefit ratio when determining the best treatment. Across the board thinking – a one size fits all mentality – is no thinking at all!

Unfortunately, many people are increasingly skeptical of vaccines, especially since the development of the Covid vaccines. This is alarming, not only for the good of those people, but for the country as a whole, too.

Allysia Finley, writing in The Wall Street Journal, describes the contrast in political messaging between Republicans and Democrats: “Republicans cheered when Covid-19 vaccines rolled out two years ago. “I think the messaging should be, ‘Get a vaccine because it’s good for you to do it. It works. You’re not going to have to be doing anything abnormal. You can live your life,’” Florida Gov. Ron DeSantis said in April 2021. The message from the Biden administration and public-health officials has been different: Vaccines are safe and effective. Period. Those who don’t trust us should shut up.”

This contrast in messaging has led many to distrust their government and public-health officials – especially conservatives who are generally more distrustful of government. This is not necessarily the correct reaction, but it is understandable.

When vaccines were first developed during the Trump administration against all odds, they were rightly hailed as a great achievement. At the time, thousands were dying daily of this new coronavirus called Covid-19. There was tremendous political pressure to come up with a solution to this pandemic and the Trump administration achieved a great victory when the vaccines were developed in record-breaking time. There was great enthusiasm for the vaccines and skepticism was quite low.

But skepticism has been fueled since that time by overzealous public-health officials who oversold the benefits of vaccines, pushing them on children who are at low risk for serious illness, mandating shots while playing down potential side effects, and smearing those who raise concerns as spreading misinformation. We now know of collusion between the Biden White House and tech companies to suppress any scientific discussion that questioned the public policy statements of this administration.

Dr. Anthony Fauci, once heralded as the world’s leading authority on infectious diseases, was among those who misled the public in May 2021. “When you get vaccinated, you not only protect your own health and that of the family,” he said, “but also you contribute to the community health by preventing the spread of the virus throughout the community.” Fauci may have believed what he was saying, but the vaccine trials didn’t show they prevented transmission. That fact was withheld from the public as an inconvenient truth.

We also didn’t know much when the Covid vaccines were introduced about the extent to which the virus would mutate. But viral mutation was certainly well-known from our experience with other viral infections such as RSV, influenza, and other endemic human coronaviruses including the common cold. Reinfections are common with all these viruses.

To make matters worse, recently released emails reveal that some FDA officials were concerned the agency’s review of Pfizer’s vaccine during the summer of 2021 was being rushed. The vaccine had been authorized for emergency use in December 2020, but full approval requires a significantly more comprehensive examination of safety, efficacy and manufacturing data. Marion Gruber, then director of the FDA’s vaccine research office, warned Acting Commissioner Janet Woodcock in a July 21, 2021, email that the “hyper-accelerated” review would “undermine confidence in the vaccine (and, indeed, in FDA’s credibility).” In hindsight, Gruber was correct.

The FDA reviewed and approved Pfizer’s application in less than a third of the time it takes for a typical drug approval. The Biden administration and many Democratic governors soon imposed vaccine mandates without exceptions for prior infection. They dismissed Americans who cited studies showing the protection offered by natural immunity. This is a clear case of political triumph over scientific understanding by those who pretend to “follow the science.”

As vaccine protection against infection waned, public-health officials pushed boosters despite little evidence that their benefits outweighed the potential safety concerns for healthy young people such as myocarditis. Officials also rushed last summer to roll out vaccines for children, who are at extremely low risk for severe illness. Yet vaccinated toddlers in Pfizer’s trial were more likely to get severely ill with Covid than those who received a placebo! Most kids who developed multiple infections during the trial were vaccinated. These findings warranted closer examination – which did not happen.

The problem we are seeing here is that government elites believe they, and only they, are best equipped to make complex medical decisions for the people and any information that contradicts those decisions should be withheld from the public. Therefore, we should not be surprised when those who distrust government in general make personal decisions that may not be in their own best interests.

Vaccines are a wonderful scientific advancement that have benefited millions and saved millions of lives. But full disclosure of the risks and benefits would go a long way toward re-establishing trust in our public-health officials.

The School Choice movement is gaining momentum across the states with good reason – it is raising the educational prospects of our nation’s children. School Choice has been regarded as a Republican issue for many years but that is changing – at least in the minds of the people, if not the politicians.

The reason is simple. Every parent wants their children to have the best possible education. Education is the key to economic advancement – especially for those who begin life in poverty. Government handouts may improve the life of some low-income families, but a good education can open doors of opportunity like nothing else. Dr. Ben Carson, retired neurosurgeon, former presidential candidate, and Secretary of Housing and Urban Development is one good example. Condoleezza Rice, former Secretary of State, and Senator Tim Ryan of South Carolina are two other good examples. The American Dream is still available for those who get a good education.

But getting that good education depends on where you live and the financial status of your parents in too many cases. School Choice is the means to put those obstacles behind all children.

Recently, two states have taken big steps toward making School Choice a reality for their residents. Iowa passed its version of Education Savings Account (ESA) legislation first. Governor Kim Reynolds signed the new legislation into law, providing more than $7,500 for any student to use toward private-school tuition and other education expenses. Utah followed with their ESA bill, which makes $8,000 available to every student. There’s no income cap on families who can apply, though lower-income families receive preference and the program is capped at $42 million. The funds can be used for private school tuition, home-schooling expenses, tutoring, and more. Governor Spencer Cox has suggested he supports the bill, which includes pay raises for teachers.

The Wall Street Journal editorial board says, “It’s a promising start to a year in which many states are eyeing school choice: About a dozen other state legislatures have introduced bills to create new ESA programs, and several want to expand the ones they have.” 

In Florida a Republican proposal would extend the state’s already robust scholarship programs to any student in the state. The bill would remove income limits that are currently in place for families who want to apply, though lower-income applicants would receive priority. It allows families to use the funds for expenses other than tuition, including courses of study for home-schooling, tutors and tests. Home-school students would be eligible for funds for the first time.

Reforms are being currently considered in South Carolina where legislators are considering a new ESA program for lower-income students. In Indiana, a Senate bill would make state ESAs available to more students. An Ohio bill would remove an income cap and other eligibility rules for the state’s school vouchers. ESA bills are in some stage of legislation in Oklahoma, Nebraska, New Hampshire, Texas, and Virginia.

Arizona set a new standard for state education policy last year with ESAs for all students. Florida has been its chief contender for the top spot, but other states are now in the race – and November’s elections put many in a better place to advance ESAs.

WSJ says, “All of these reforms share a common principle, which is that state money for education follows the child and not the school system. (emphasis mine) The hope is that this empowers parents, rather than unions and education bureaucracies that have dominated school governance and prevented learning improvement and higher standards that U.S. student desperately need.”