Wrapping things up: Here's Andrew Yang's healthcare plan

This is the last in my 2020 Democratic Presidential Candidate Healthcare Policy series. In some cases I did wonky, in-depth analyses; in others I've simply given an overview with some notes here and there.

Andrew Yang's falls into the latter category, not because of any bias against him, but simply due to a lack of time on my part to give it a more detailed review.

Officially, Yang supports "Medicare for All", but like several other candidates both now and in the past, this isn't quite the same "Medicare for All" that Bernie Sanders is pushing (and which Elizabeth Warren is mostly still pushing):

We are having the wrong conversation on healthcare.

Instead of addressing the underlying problems driving unaffordability and access, we Democrats are spending all our time arguing over who is the most zealous in wanting to cover Americans. Over who has wanted to do so longer. Over who cares more about the health of Americans.

We talk about how we’re going to pay for it, but the reality is we’re already paying for it. We pay for it when we can’t switch jobs. We pay for it when new jobs are temp or gig jobs that don’t provide healthcare. We pay for it when all of our prices are higher. We pay for it when healthcare costs drive us into bankruptcy.

To be clear, I support the spirit of Medicare for All, and have since the first day of this campaign. I do believe that swiftly reformatting 18% of our economy and eliminating private insurance for millions of Americans is not a realistic strategy, so we need to provide a new way forward on healthcare for all Americans.

Welp. There you have it.

As Democrats, we all believe in healthcare as a human right. We all want to make sure there is universal affordable coverage. We know we have a broken healthcare system where Americans spend more money on healthcare to worse results. But, we are spending too much time fighting over the differences between Medicare for All, “Medicare for All Who Want It,” and ACA expansion when we should be focusing on the biggest problems that are driving up costs and taking lives.

We need to be laser focused on how to bring the costs of coverage down by solving the root problems plaguing the American healthcare system.

That means controlling the COST OF PRESCRIPTION DRUGS. That means INVESTING IN INNOVATIVE TECHNOLOGY to cut waste and boost access. That means changing the incentive structure for providers. That means SHIFTING OUR FOCUS on more stages of care. That means revamping what COMPREHENSIVE CARE means in the 21st century to include crucial aspects of WELLBEING. That means taking on the powerful lobbyists in D.C.

Diagnosing and addressing these underlying problems is the first and most important step in ensuring everyone has access to healthcare, because we cannot extend quality coverage to everyone without real strategies on how to avoid the toxic incentives of our current system. We can’t afford to mess this up.

Fundamentally, we need to have a more productive conversation about healthcare in America. It’s time to take a step back from enrollment mechanisms and creative accounting to focus on lowering costs and improving quality.

My FULL PLAN for a New Way Forward for Healthcare in America is a statement on the critical failings of our system and viable paths to solve them. We cannot find the answers to one of the most serious problems in modern American history unless we are asking the right questions. It’s time we start asking the right questions.

Well, now.

Of the various candidate plans, Pete Buttigieg is the only other one I know of who's made provider reimbursements (that is, how much we pay hospitals and doctors) a major focus of his healthcare proposals...and even then, Buttigieg still pushes improved payment mechanisms (expanded subsidies, a public option, etc) above the provider side. Yang makes this side of the equation front & center, which is interesting.

OK, let's look at his full plan:

We need to fix our broken healthcare system by tackling the root problems through a six-pronged approach:

• Control the cost of life-saving prescription drugs, through negotiating drug prices, using international reference pricing, forced licensing, public manufacturing facilities, and importation.

• Invest in technologies to finally make health services function efficiently and reduce waste by utilizing modernized services like telehealth and assistive technology, supported by measures such as multi-state licensing laws.

• Change the incentive structure by offering flexibility to providers, prioritizing patients over paperwork, and increasing the supply of practitioners.

• Shift our focus and educating ourselves in preventative care and end-of-life care options.

• Ensure crucial aspects of wellbeing, including mental health, care for people with disabilities, HIV/AIDs detection and treatment, reproductive health, maternal care, dental, and vision are addressed and integrated into comprehensive care for the 21st century.

• Diminish the influence of lobbyists and special interests in the healthcare industry that makes it nearly impossible to draft and pass meaningful healthcare reform.

I'm mostly gonna just go with the bullets from each of these sections:

As President, I will…

• Work with Congress to pass a law 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.

Most of this is pretty standard, although having the federal government step in as a public drugmaker themselves is unusual...although I believe Elizabeth Warren has included this as a possibility as well.

As President, I will…

• 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.

I honestly don't know too much about telehealth, but it certainly makes sense to ramp up its use where appropriate, especially given the dramatic advances in telecommunication technology and the availability of ultra-high bandwidth wireless internet live feeds.

As President, I will…

• 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.

WARNING. Danger, Will Robinson. Look, frivolous lawsuits are certainly a problem, but this is setting off red alert klaxon "tort reform" alarms left and right.

• 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.

Yeah, OK. The ACA was supposed to move doctors and hospitals over to EHRs by now, I believe, but doctors have been notoriously resistant to it, and I'm guessin there are logistical and legal problems involving privacy and HIPAA, so I'm a bit skeptical that this would actually happen.

As President, I will…

• 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.

Here's where Yang's proposals start to get a bit concerning:

As President, I will…

• 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.

On the surface, some of these make sense...but, well, I'll turn this part over to my friend, lawyer and disability activist Matthew Cortland, who says:

I'll save y'all some time: Yang's healthcare "plan" isn't so much a plan as it is incoherent, ableist musings...It reads like a moderately well researched proposal in a first semester MPH service and delivery course from someone who had an unrelated undergraduate major.

I think it was @jonfavs who said something like Yang is good at stating the problem but his solutions...aren't. "The demand for physicians is outpacing the available supply" - for half a second I thought the next sentence was going to be "so we must lift the Medicare GME caps...NOPE! His solution is to allow "licensed physicians to administer medical services and medication through telehealth services" without needing a "redundant license" in the state they're telehealthing in to.

Although he talks about it a bunch, it’s not clear to me whether Yang would allow NPs to practice … under the supervision of a remote doctor? or AI? But he seems to be against allowing NPs to practice without supervision.

Back to Yang himself...I'm gonna skip over most of this:

As President, I will…

• 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.

I'm glad to hear he supports repealing the Hyde Amendment, but something tells me this last promise wouldn't hold.

• 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.

Well now. I'm stunned that he sort of buried his Public Option in near the end as a small bullet point instead of making it a major cornerstone of his proposals...but that's exactly what he's done.

• 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.

Again, I applaud the "corruption purity" standard here, but that's gonna be a difficult one to keep. ANYONE who's ever worked as a Phrma exec? Even for, say, one week as a junior vice-president of research or whatever? That's gonna make it more difficult to get people who understand the industry in your administration.

• 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.

Um...huh? He's basically going to bribe ex-administration employees not to accept bribes? Wouldn't it make more sense to beef up the anti-lobbying laws we already have?

• Provide every American voter with $100 Democracy Dollars for each election cycle to protect their representatives from medical lobbyists.

Ummm..."Democracy Dollars"? There's something like 220 million registered voters in the U.S...that's $22 billion per cycle, or $11 billion per year, given out to voters to turn around and donate to a Congressional candidate of their choice? Is that on top of his $1,000/month Basic Income giveaway ($3.9 trillion per year)? And how is that supposed to "protect their representatives from medical lobbyists"? I mean yes, it would likely help low-funded candidates raise more money...but wouldn't that just give their opponents even more incentive to take lobbying bribes in even larger amounts?

• 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.

Now that sounds reasonable to me.

So...there you have it. There's some useful and interesting ideas there, but in terms of concrete proposals to specifically reduce premiums, deductibles and co-pays, there's almost nothing you can really lock down. It's like trying to nail Jell-O to the wall...yes, it's tangible but also awfully amorphous for the most part. He never actually talks about the Affordable Care Act (other than a very brief mention at the beginning), and his sole Public Option reference is buried in the end, making it difficult to "compare" to the other candidate proposals.

In some ways that might not be such a bad thing, I suppose; at least it shows some "outside the box thinking", etc etc...but it's still hard to get a read on.