On the Issues
A Market-Based Plan to Reduce Healthcare Costs and Enhance Quality
1) Change payment structure
How the healthcare industry makes money needs to reform. Currently, providers get paid separately for individual services. This creates an incentive for a high volume of care that does not lead to better outcomes. This high volume-poor outcome structure can be changed by changing how we pay healthcare providers.
By bundling payments across private and public providers, they receive a single, stable, all-inclusive payment for all services related to a person's care during a certain period of time. These bundled payments can be scaled to the length and intensity of care. They encourage care coordination and have saved $3 billion in Arkansas, currently the sole adopter.
Hospitals are also a major driver of the cost of healthcare. A global budget is much like bundled payments. Instead of being paid for individual services, hospitals are given a single budget for an entire year by the state. This budget would be based on a given hospital's prior expenses, performance, and projected changes. Such a model saves people money because it eliminates the incentive for increasing the volume of care, and instead focuses on quality of care and patient outcomes. A global budget also helps rural hospitals by providing a steady funding source which ensures every Pennsylvanian access to quality, affordable care. The sole adopter, Maryland, saved $100 million in its Medicare program in the first year.
2) Publish cost & care data
A major reason behind outrageous healthcare prices is the lack of transparency in how services are rendered.
By publishing a state-wide and county-level scorecard, we can allow the public and watchdog organizations to keep healthcare providers and insurance companies honest in their pricing and demand higher quality care.
By creating a claims database where all private and public payers submit data on all health claims we can help people choose the most affordable, highest quality care in their area. Such data can also guide insurers and regulators to control costs by reducing the variation in prices for services and measuring the impact of other reforms. 18 states have already created such databases. Maine specifically found in their data that they could reduce unnecessary hospital admissions by 50% reducing private medical spending by 11.5% and Medicare spending by 5.7%.
By coupling the claims database with requirements for provider-specific binding estimates on the price of services, consumers can make the most informed decision on where and how they receive care. These changes would encourage honest competition and drive down prices for everyone.
3) Reference pricing for state employee plans
Employee health plans account for a significant portion of state expenditures. Pennsylvania should identify and refer employees to low-cost, high-quality service providers. This would set a standard and reasonable maximum price the state would pay for healthcare. State employees would still have the option to choose more expensive services; but because more expensive care does not equate to better care, they would be responsible for paying the difference. This "reference pricing" would help reduce wasteful spending. California implemented this policy in 2011 and saw prices for referred services drop by 26%, saving the state $5.5 billion in 2 years.
Data in this section was sourced from here.
Supporting Safe Staffing
We need to protect our nurses and their patients. The majority of Pennsylvania nursing departments are understaffed and overworked. Hospitals have up to 9 patients per nurse which raises the risk of mortality by as much as 35%. Adequate staffing of nursing departments saves lives. We need to pass the Safe Staffing Bill, and when you send me to the state house, this bill will be a top priority.
Modernizing the Minimum Wage
At the center of any strong community is a thriving economy which facilitates success for its citizens. We can only achieve this by ensuring a fair and livable wage. The definition of a livable wage isn’t consistent across all of Pennsylvania’s 66 counties however, which is why I propose a statewide base minimum wage of $10.10 with a county-by-county cost of living adjustment so that all of Pennsylvania’s workers are guaranteed the compensation they deserve. Moreover, I will fight to ensure that any changes to the minimum wage are tied to inflation, so that we never have to have this debate again.
Protecting our Unions
I believe so-called “right to work” laws are best called “right to be exploited” laws. Union workers built this community, built this country, and gave us the labor rights and protections we enjoy today. Their sacrifices will neither be forgotten, belittled, nor erased. Unions deserve a Harrisburg that stands with them. The 57th deserves a representative which will stand for its workers. When you send me to Harrisburg, I will ardently oppose any measures that undermine our unions.
Ending Wage Theft
Wage theft is a malicious and criminal act. It is a corrupt practice designed to fill the pockets of the conniving and heartless, and leave the most financially vulnerable among us in a continued state of economic disparity. Whether it is being paid below the minimum wage, being paid less than negotiated, or being denied overtime pay, Pennsylvania is too proud and noble a state to allow these violations to persist.
We must provide the Department of Labor the funding and resources it requires to fight back against wage theft. The General Assembly needs to expand our legal measures, monitoring efforts, and enforcement capacity to tackle this issue head-on. Let’s back our unions, so when workers lose the salary they have rightfully earned, they have a community for support. Harrisburg must mobilize a comprehensive educational campaign so that the rights of every worker are widely understood. Let’s stand together to ensure that their voice is heard and justice is fulfilled, even for those too fearful to report wage theft on their own
Improving Teacher Working Conditions
One of the most important duties of the state is to educate our children. As a state, we need to empower these teachers who have dedicated their lives and their own education to make a meaningful impact on our children. Their drive and ability has been stifled by Harrisburg's mandate that they "teach to the test," as well as by a lack of professional support and woefully inadequate wages. These issues have driven away many qualified educators to leave their careers and robbed our children of the education they deserve.
We need to trust the skill and professionalism of our teachers. Teachers need to be decision-makers in their schools. They should have better professional support and feedback. They and our children deserve more than to be drilled on how to pass a standardized test that does not reflect the reality of life or the workforce. Teachers deserve to be paid a reasonable salary which reflects their importance as part of the bedrock of our community.
Our legislature has a responsibility not just to get out of the way and let hard-working professionals do their job, but to embrace and foster the passionate drive of teachers, who dedicate their lives to empowering and building the future of our state.
Modernizing the Curriculum
Our children should also be empowered to reach their full potential. I believe in bringing back and expanding the programs that give our kids a broader view of the world than just what is in a textbook. Evidence shows that phys-ed, music, and art programs not only improve physical and mental health but also, and most importantly, lead to better learning outcomes. In the same way we should let teachers teach, let kids be kids, and have a wholesome education beyond just reading, math, and science.
Being a productive citizen in society demands more than just the skills to succeed in one's profession. It also requires knowledge on how to navigate the world. Knowing how to manage one's money and make good financial decisions is important. Moreover, our kids already live in a world where they will have to sift through conflicting information and think critically to make tough decisions. I support expanding the curriculum to include financial literacy and rhetoric so that our children can be given the tools they need to truly thrive.
Reducing the Size of the Legislature
The era of unaccountable government in Pennsylvania needs to end. We deserve more and should expect more from our legislators in the General Assembly. We do this first by making the General Assembly more efficient, having 203 representatives does nothing for us if nothing gets done.
Ending the Legislator-Lobbyist Pipeline
The idea of a pipeline from legislator to lobbyist should make any good citizen sick. The current 2 year waiting period is meant to create a safe and ethical distance between current legislators and their former colleagues; but no one believes that 2 years is even remotely enough to accomplish that. 5 years is the standard the federal government sets, so the least we can do is catch up to the national standard.
Committed to Moral Leadership
We are the Keystone State because we are the keystone for American democracy, it is time that we stay true to that mantle. That is why I pledge to work towards common bipartisan solutions in Harrisburg, to never accept a gift from a lobbyist, and never take a corporate donation. I think its time to end unlimited campaign contributions in Pennsylvania. I won't just talk about changing the political culture in the state capitol but I'll live, breathe, and act towards that change.
Committed to Staying Connected
I pledge to never lose touch with the people of our district. As representative, I will hold office hours on Saturdays, as well as frequent town halls and live streams to connect with our community. Representatives should represent, and to do that they need to be present and actively seeking the consensus of all their constituents, answer hard questions, and represent all members of the community no matter their party.
Ensuring Pharmaceutical Ethics
Dozens of articles have been written about the role the pharmaceutical industry had in causing the opioid epidemic. Blatant lies to doctors and patients have fueled a crisis which the National Institute on Drug Abuse says that in 2015 alone, "more than 33,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid. That same year, an estimated 2 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers, and 591,000 suffered from a heroin use disorder (not mutually exclusive)." Pennsylvania is ranked #5 in the Nation in drug-overdose deaths as of 2016. In terms of deaths per 100,000 people, Pennsylvania jumped dramatically from 15.3 in 2010 to 37.9 in 2016. The Governor has declared this a statewide health emergency.
Moreover, according to a study done by Pew Research, the pharmaceutical industry spent $24 billion in 2012 marketing to doctors, more than 8 times the amount they spent on direct-to-consumer marketing. $15 billion of that went to face-to-face promotions with doctors. In fact, most drug companies spend more on marketing than they do on research. What they do with that money is send people unqualified to discuss complicated pharmacological topics with medical professionals to not only mislead but effectively bribe doctors and their offices. This tactic abuses the inherent trust that people have in their doctor and undermines the doctor's oath to do what is best for their patient.
This gross corruption and insidious manipulation needs to end. Drug companies should not be able to buy the influence of doctors. The General Assembly needs to establish ethics rules for pharmaceutical marketers which should include the following:
No pushing off-label use
No offering gifts of any kind including food, money, or titles.
Pharmacological training and state licensing for drug marketers
- Doctors who are paid to market drugs be required to disclose their conflict of interests to patients.
We need to take a stand so that something like the magnitude of the opioid epidemic never happens again.
Establishing a Center of Excellence
Substance abuse is a complicated disease which stands at the intersection of social, economic, emotional, and mental forces. Treatment needs to provide care which addresses the complicated and multi-faceted nature of substance abuse.
I support establishing Substance Abuse Center of Excellence to be a healthcare coordinator with the mission to provide guidance and assistance to substance abusers and their loved ones. This organization would direct people to comprehensive care to ensure recovery, not only through rehabilitation but also overdose prevention, mental health services, and alternative pain management.
Expanding Evidence-Based Treatment
Medication combined with behavioral therapy, good health, and social integration (employment and family services) is proven to help people recover from substance abuse, reduce the likelihood of relapse, and reclaim their lives. Such a treatment regimen should be a patient's first reference for treatment and recovery. We must also educate people on what evidence-based treatments are. They are not silver bullets, nor are they "replacing one drug for another." They are what scientists and medical professionals through rigorous study have seen works best. We have no trouble with the idea of using nicotine patches to recover from tobacco addiction, and there are support groups and therapies which work to help people recover from alcohol addiction. We should apply the same thinking to opioid abuse.