By SARA ARTHURS
Congress has been debating for months — really, for decades — how to change the health care system in America.
Bill Ruse thinks he knows the way.
Ruse, former president and CEO of the Blanchard Valley Health Association, has written a book, “A Prescription for Healthcare Reform: Fact Book and Road Map,” with co-author Donald Stansloski, a former Ohio Northern University professor and the founder and emeritus dean of the College of Pharmacy at the University of Findlay.
Ruse began his health care career in the 1950s as a pharmacist, then served as president and CEO of Blanchard Valley Health Association for 36 years before retiring in 2001.
Ruse and Stansloski start their book by noting that the United States spends more on health care than any country, yet its health care system is ranked 37th in the world.
In 2014, the United States spent an average of $9,024 on health care services for every individual, compared with $3,620 on average for all countries in the Organization for Economic Co-operation and Development.
Switzerland, the next-highest expenditure country, spent $6,787 per person. It ranks ninth in the world in life expectancy. The United States ranks 43rd.
Infant mortality in the United States is 5.8 percent, placing it behind 54 other nations. Ohio’s infant mortality rate was 7.2 deaths per 1,000 live births in 2015, and the rate for black infants was 15.1 deaths per 1,000 live births.
So, the book outlines a plan the authors say will not only save money, but also keep people healthier.
It starts with restructuring Medicaid.
Medicaid is the federal-state health insurance program primarily for low-income Americans. The federal government pays, on average, 57 percent of the costs, but each state has its own program with its own eligibility rules.
Ruse calls for having Medicaid entirely managed by the federal government — as is now the case with Medicare, which is health insurance primarily for seniors and those with disabilities. He argues that this would save the states $200 billion in annual administrative costs. This could pay for state tax reductions and save legislators time, he said.
“If you lift this burden from the states, it is such a windfall,” Ruse said.
Ruse said “the party line” is often that states should have more control, and the federal government less. But he pointed out that administrative costs for Medicare are a small fraction of what they are for either Medicaid or private insurance, so Medicare is run more efficiently.
The book suggests creating a Medicare Part E, which would encompass what is now Medicaid, with eligibility and benefits standardized nationwide. The authors say a payroll tax could fund this, but may not be needed because their plan also includes cost reductions in pharmaceutical purchasing, long-term care insurance changes and billing costs.
Saving states money in administrative costs would allow them to invest in local health departments and community health centers, to provide prenatal and postnatal care to pregnant women, care to young children, and expanded mental health and addiction treatment, the book argues.
Special emphasis would be placed on opiate and other addiction services.
The authors anticipate reducing infant mortality from 5.8 deaths per 1,000 live births to 2.5 deaths per 1,000 births.
Slightly more than 5 percent of Americans purchase long-term care insurance, the book states. (Medicare will not pay for nursing home care in most circumstances.)
The book notes that, although Americans are encouraged to save their money, “Left unsaid is the fact that being thrifty and saving are often like building a structure where a future sinkhole will develop.” This is because extended stays in a long-term care facility can drive someone into poverty, leaving Medicaid paying for the care.
Medicaid paid for 62.3 percent of nursing home care in 2010, the book states.
So, Ruse and Stansloski call for the federal government to develop a long-term care insurance program, financed by a 1 percent payroll tax paid by employers and employees starting at age 40, with the goals of significantly reducing Medicaid expenditures, and reducing the likelihood an individual or family will become impoverished.
Long-term care can impoverish someone even if they are “quasi-wealthy,” Ruse said. With something like Alzheimer’s disease, a patient can be in a nursing home for years. “You will absolutely wipe out your savings,” Ruse said. “And what’s left? Medicaid.”
Think this is a problem now? Keep in mind how much worse it’s going to become, the authors say. After all, the Baby Boomers are aging. The number of elderly Americans is expected to more than double in the next 40 years.
“It can bankrupt us,” Ruse said.
The book notes that a significant portion of administrative overhead in health care is billing- and insurance-related. Costs were $471 billion in 2012, according to one estimate, and are projected to be $573 billion this year.
The plan calls for developing software “that takes the results from all exams and services, applies the proper code(s), and sends a bill and collects payments.”
The federal government would pay for developing this software and supply it for free to the states, which would then set up statewide billing exchanges. The book notes that modern technology, after all, can pilot driverless cars or send a drone to a specific address.
Ruse acknowledged that simplifying hospital billing and coding would put people who do those jobs out of work.
“There’s a concern, and certainly I’m not insensitive to that,” he said.
On the other hand, these workers could be retrained. He noted that there are shortages of workers in other medical professions.
“Look, we need nurses. … These folks, they know the terminology,” he said.
Ruse said pharmaceuticals and technology are available that weren’t when he started practicing pharmacy in the 1950s. They are the two driving things that have “kept us alive longer,” he said. But they have kept people alive in Canada, too, and other countries that spend a lot less per capita on health care than we do.
The book notes that the United States spends 2.04 percent of its gross domestic product on prescription drugs, more than any country except Hungary and Greece. The U.S. spends an average of $1,112 per capita, compared to the next highest country, Canada, which spends $772.
The authors compared the price of Symbicort, a drug used by patients with COPD. They found the lowest price for a Symbicort inhaler in the United States was $323.61, while the Online Pharmacies Canada price was $74.37. This means a patient would save nearly $3,000 annually by using a Canadian pharmacy.
Ruse and Stansloski suggest that the price for drugs in federal government programs, including Medicare, be based on the average costs paid by the governments of Canada and Mexico.
They also call for medium and large employers to pay at least 80 percent of the health insurance premiums for their employees, and for tax credits to encourage smaller employers to provide health insurance for their workers.
They propose trying out their plan in Ohio first — starting with Cleveland as a test site, then expanding it to the rest of the state, then the country.
“In the history of humankind, great strides in progress often require great compromises,” the book states. “The annals of history will hold in high esteem those who laid political differences aside for the common good.”
Ruse has known Stansloski for a long while, and he said Stansloski — co-author of eight books as well as several academic papers — contributed a deeper knowledge of the writing than Ruse himself. In addition, Ruse wanted the book to be apolitical.
He calls himself a moderate Republican and said Stansloski is a moderate Democrat, offering a different perspective.
The authors state, “Our view is that health care is indeed a right, and our country should bestow it equally on all who are U.S. citizens.”
Having taken that stance, “We can’t be comfortable” with health care plans recently proposed by Congress, which would lead to millions losing benefits, Ruse said.
Ruse said feedback for the book so far has been good, but he worries whether it will be well received, especially among those who are “very, very conservative.”
But, he said, “You have to look at the underlying facts.” American babies “are dying within the first year of life” more than in most other developed countries, and Americans don’t live as long.
Last fall, Ruse enrolled in a doctoral program at Walden University in Minnesota. Now 82, he said he questioned whether to go back to school, but had always wanted to work on a Ph.D.
He ended up leaving the program, but researching and writing academic papers reminded him how he had always wanted to write a book.
Ruse said the idea for this book came out of his perception that public officials were not tackling the issues. Even though Americans spend a lot on health care, “We’re not getting our money’s worth,” he said.
His hope was to address the ranking of the United States as a leader in health care, “not just the one that spends the most.”
Ruse said his approach is not really a change to the Affordable Care Act — also known as Obamacare — and goes beyond what is being debated in Congress.
“It’s rather a system reform,” he said.
Everybody looking at health care is looking at a “very small piece of it,” not the overall picture, he said.
The book is available on Amazon in print and Kindle form. Ruse also ordered 30 copies, and has some available if local people are interested.
He sent it to U.S. Rep. Bob Latta, R-Bowling Green, and also sent a copy to President Donald Trump — although, he said, he doesn’t expect to hear back.
But, he said, making changes like he suggests could mean that, instead of having a health care system ranked 37th in the world, we could have a country where people are living longer, fewer babies are dying and costs are reduced — so the president and Congress could say, “Look what we did. We made a difference.”
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By SARA ARTHURS