Planks for Platform

HEALTH CARE

We support pilot demonstrations that can provide models for licensing-free medical marketplaces. We recognize the total elimination of medical licensing laws throughout the U.S. may not be politically feasible at this time because there are currently no countries, states or regions that can serve as a model for eliminating licensing. Perceived market imperfections may include consumers requiring some licensure laws to assure medical professionals have been adequately trained.

Meanwhile, we support other steps that can provide economic freedom, increase supply, satisfy demand and create competition among health care professionals. These include relaxing licensing restrictions against foreign-trained physicians, physicians from other states, telemedicine, and mid-level clinicians, and increasing medical school enrollments, internships and residencies. We also support repealing state regulation of medical facilities, and insurance and drugs.

The two major parties caused America’s health care “crisis” by creating monopolies (and oligopolies). Republicans support private monopolies, while seeking to cut costs by promoting private insurance with less coverage and limiting malpractice awards. Democrats support public monopolies or nationalization (e.g., insurance), while seeking increased government coverage with price controls that will further erode quality.

We disagree with the economic policies of the two major parties that create monopolies by restricting supply to meet only perceived need and shortages of physicians and medical facilities. There is no evidence to support their prevailing economic theory that “physician supply can create its own demand” (i.e., which means increasing the supply of doctors and hospitals will just motivate them to convince “ignorant” consumers to order more unnecessary and expensive health care).

Restricting supply has inflated costs and ballooned debt. It has also increased unmet demand in rural and poor urban areas, preventive care, geriatrics, house calls, cost management, computerized medicine, entrepreneurism, medical supply, environmental protection, public-health services, mental institutions, drug programs, military and foreign service, and pandemic control.

We recognize the model for increasing supply to meet demand as Europe, especially Germany. Continental Western Europe has 40% more physicians and hospital beds per population size relative to the U.S. Meanwhile, European countries typically receive health care at prices that are less than one-half of those in the U.S. and they spend less than one-half as much per person on health care overall.

We support the removal of federal entry barriers to foreign-trained physicians. The integration of the European Union allowed high numbers of doctors to emigrate from former communist countries in Eastern Europe into continental Western Europe. The U.S. also used a high percentage of foreign-trained physicians to meet the increased need created by Medicare and Medicaid since 1965.

We support current efforts to increase workforce mobility by recognizing licenses issued by other states. We support the ability of comparably-licensed health care professionals to practice across state lines, including telemedicine.

We support current efforts by organizations representing mid-level clinicians — such as nurse practitioners, physician assistants, nurse midwives, physical therapists, podiatrists, and optometrists — to continue to achieve broader scopes of practice for their members, including performing many of the duties performed by physicians. However, we oppose efforts by these same groups to limit the scopes of practice of other clinicians, and raise education requirements for new entrants into their professions.

We support the education of all qualified medical school applicants. We support the free flow of qualified students into medical colleges. Germany is now relaxing entrance requirements for domestic students. We encourage medical colleges to complete the education of all qualified medical school students. We would oppose any efforts to unnecessarily flunk students out of medical colleges, like now currently occurring in France. We would also oppose any efforts to increase the failure rate of medical graduates on licensing tests.

We oppose the current U.S. system that allows the American Medical Association and other professional associations to accredit and limit the number of U.S. medical schools and students. If government accreditation is deemed necessary, it should not be conducted by medical special interests, and the government should approve all schools that meet standards. The medical schools themselves should determine the number of students, specific educational needs and costs for training.

So as to not discourage new students from pursing the health care professions, subsidies (e.g. vouchers) may be needed to maintain a level playing field with past graduates who have already had their currently very expensive education subsidized. But subsidies should no longer be granted directly to medical schools, but rather follow only students, to promote admissions and competition at medical schools. Subsidies should be phased down or even out on a per student basis, especially as medical education becomes more competitive.

We oppose the current system that allows the Accreditation Council for Graduate Medical Education (ACGME), comprised of the American Medical Association and other professional associations, to accredit and limit the number of graduate medical training programs (i.e., internships, residencies, and fellowships, a.k.a. subspecialty programs). If government accreditation is deemed necessary, it should not be conducted by the medical industry, and government should approve all programs that meet standards. Subsidies provided by Medicare should be phased down or even out. The programs themselves should determine the specific needs and costs and benefits for physician training.

We support the repeal of certificate-of-need laws in the two-thirds of the states that are still using them to limit the supply of hospitals and other medical facilities. Such laws have already been repealed in about a third of the states. We oppose similar policies restricting supply, such as those requiring approval for the building of additional hospital beds in Minnesota.

We support the elimination of laws in 30 states (not including Minnesota) that limit damages in medical malpractice lawsuits.

We oppose state regulation of health insurance. The insurance industry has been concentrated and even monopolized in many states and some insurance companies claim the complexity of multi-state regulations has prevented them from entering new markets. A perceived market imperfection is consumers need some protection, especially regulations requiring insurance companies to have adequate capitalization to cover losses. If elimination of state regulation of health insurance is politically infeasible, we support the elimination of laws preventing people from purchasing health insurance across state lines, which prevents consumers from seeking coverage from states with less regulation. We would oppose national regulation of health insurance.

We oppose compulsory insurance plans, including Obamacare. We oppose national and state mandates requiring coverage of government-selected health conditions. We oppose regulations of health insurance that limit factors that can be used to set rates. Insurance companies should be able to raise rates for pre-existing conditions. Rates for some consumers (e.g., older people) should not be subsidized by other consumers (e.g., younger people). Rates increased by pre-existing conditions are often not large and, when they are, could be more fairly subsidized by government.

We oppose tax supported plans supplying insurance and health services, including Medicare, Medicaid and Obamacare. However, a perceived market imperfection is the elderly and poor require subsidies due to the high costs of medical care and their limited incomes. Subsidies should be reduced and eliminated as competition reduces prices for health care services and wealth disparity is alleviated through free markets in all industries.

We oppose the use of buyer monopoly power by Medicare, Medicaid and large companies (e.g., HMOs) to effectively set price and quality controls on providers, shift costs onto others, and promote insurance and provider monopolies. We support repeal of the ERISA Act, which exempts employee health benefit plans offered by large employers from lawsuits brought by people denied coverage. We oppose tax-deductibility for group premiums. Other insurance and provider companies are forced to merge to improve market power for negotiation of prices. The primary barrier for an insurer looking to enter a new market is the cost of building up a provider network at discounted prices and developing enough business to spread risk.

We support reducing the lifetime of drug patents and eliminating extensions. We recognize that new drugs require expensive research and development, and the possibility of the market imperfection that new drugs may need to be awarded temporary patent monopolies to recoup their investment. However, the drug industry is reaping excessive profits from extreme prohibition of competition. Moreover, competition between medical practitioners and facilities can reduce the cost of drug development. Expensive clinical trials should probably receive some monopoly patent rights. Appropriate government patent ownership of drugs discovered and developed with taxpayer money should be retained.

We oppose non-patent drug monopolies. We oppose the five-year exclusivity for small molecules, 12-year exclusivity for biologics, and six-month pediatric exclusivity. When there are no patents, Federal law should not prohibit the Food and Drug Administration (FDA) from approving a copy of a new drug. We oppose Federal law that prohibits the FDA from approving a generic drug anytime a claim of patent infringement is alleged. We oppose laws that require the use of a specific medication once it has been prescribed by a physician.