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How to Fix Healthcare: A Conversation with Den Bishop

The Holmes Murphy executive advocates for a middle path that asks both sides to give a bit.
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Den Bishop

In preparation for the 2020 election, Holmes Murphy President Den Bishop has released his second book, where he defines what is plaguing the American health system and leading to unsustainable costs. During our conversation below, Bishop advocates for what he calls a “Medicare-centric” plan that expands coverage and moves toward benchmarking or indexing provider reimbursement rates to a multiple of Medicare to control costs.

The Voter’s Guide to Healthcare: A non-partisan, candid, and relevant look at politics and healthcare in America  looks for a middle way between the left’s Medicare-for-all, which would likely eliminate private insurance and brokerages like Holmes Murphy, or the current system’s unsustainable costs and unacceptable outcomes.

Who is the intended audience for the book?

What I’m trying to do is take smart people who just don’t do health care all the time and simplify all of that discussion down so they could read. What is Medicare? What is Medicaid? What are the challenges that hospitals that were the challenges insurance company? I would hope business leaders would have an interest in it, because business leaders are actually funding that system. Most of healthcare in this country is actually funded by business, right?

What made you shoot for a non-partisan approach?

I am equally frustrated with what have been traditionally Republican and Democratic stances on the issue because they are polarized. I don’t think it can be solved until we put our partisanship aside. If you take the extremes, what I call Medicare-for-none, then a program that abolishes Medicare as we know it today and replaces it with a single government run programs on one extreme side, and what I call repeal and erase on the other, because there was no real plan to replace the Affordable Care Act. Politically, we start in those extremes. I don’t believe either of those are the right answer. 

What are the problems with the current Medicare and Medicaid system?

I was reading an article yesterday on closure of rural hospitals in this country. Too much of their care was delivered to patients who have government-sponsored health insurance, Medicare and Medicaid. And because of this, these hospitals are going out of business. And so the only way to for them to sustain was to somehow someway change that payer mix. But the hospitals are located in communities, where the people that are coming to these hospitals are going to have government sponsored health insurance, not private-sponsored health insurance. The only way for the system to really work the way it’s set up right now is to do everything you can to skew your economics to attract more private sector.

So how do we fix that problem?

The bad news is we’re not taxing enough. Also not popular. But it is it is this reality. So we need to deal honestly with how we fund Medicare so that it adequately pays hospitals and doctors and others in that in that chain. But we also need to tax appropriately so that we’re not putting a burden on future generations.

So why can’t Medicare rates work for all hospitals?

If everybody just paid what Medicare pays, then the cost of health insurance drops. And it would I mean, it’s true. I mean, you could almost assume that the cost of health insurance for everybody that has private insurance through their work that you can basically cut it in half. That’ll be awesome for the businesses, but here’s why it would be terrible. We would bankrupt the entire healthcare system in America if we did that, because of the amount of money it takes to employ that many people and maintain this many buildings. So we’ve got a requirement to go to a system where everybody pays what Medicare pays. Yes, it would lower the cost of insurance, but the cost for access to care would be catastrophic.

What do people not know about Medicare-for-all as it has been proposed in Congress?

It actually made for-profit hospitals in the country to illegal. For-profit healthcare facilities could no longer be for-profit and the government was going to have to make some remuneration to the owners of those businesses and those facilities to take them to a nonprofit status. When people think about the degree to which some of these proposals go they go, “Wait a minute, the government can’t take a for profit business and tell it that.” You own that medical facility.. We could sit there and say, “Oh, that’s a crazy idea, that’s so far from where we are today.” But it was in the proposed bill. And the majority of House Democrats in that session signed on and supported that that bill.

H.R. 676 in the 115th Congress that had 124 Democratic co-sponsors reads, “No institution may be a participating provider unless it is a public or not-for-profit institution. Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from being investor owned…For-profit providers of care opting to participate shall be required to convert to not-for-profit status.”

What are the reactions to some of your proposals and idea in the book?

I know when I say things about benchmarking or balance billing, that the healthcare provider community and the insurance community recoils. I just I have a hard time finding an answer for the 87 million (who are underinsured. And the next time we have a presidential election, if we don’t stop this momentum, we’re going to be at 100 million Americans who are inadequately insured based on the rate at which that’s growing. At some point it tips to where the American voters say, “We’re done with that whole system.

Where has benchmarking prices to some multiple of Medicare been tried?

In Montana, they did have success in a in a reference-based and indexed approach to Medicare. We do have one state that for state employees has had success. North Carolina was the second to really try, and the cities in North Texas made that attempt. If you ask insurance companies, if you ask hospital executives, do you believe in transparency? Everyone says yes. And then you say, can we have a benchmark? And everyone says no. Because there’s an economic reason to keep the system of opaque.

What is keeping significant changes from being made?

I wish we could ban the word fair. Because you could look at it and say, would it be fair to the hospital systems to have some indexing where you can’t charge what you want, now that’s probably not fair. Is it fair to employers to be paying in this market over 250% of what Medicare pays for the same procedure? Well, no, that’s not fair either. Is it fair that in the state of Texas we have the largest percentage and number of people with no health insurance protection at all? Well, that’s not fair to those people. So anytime you start solving or trying to solve the problem, you can always take one side of and say, well, that’s not fair. We should substitute the word acceptable. Is it acceptable that we have the highest number and highest percentage of uninsured people in the United States? Most Texans I think, would say that’s probably not acceptable. We need to solve that. Is it acceptable for employers to pay 250 or more percent of Medicare for the exact same services? I think most employers would probably say, that’s not acceptable. Is it acceptable to put the burden of under-insured and uninsured on hospitals who just have to provide the care with no coverage? Well, that’s not acceptable. I think if we worked on what’s acceptable, we can actually find common ground to keep the hospitals as vibrant employers and caregivers in our communities and keep businesses where they could afford this.


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