Unlocking Affordable Health Care: How Crowdsourcing is Revolutionizing Accountability

In July, the Department of Health and Human Services (HHS) revealed that millions of Americans might be wrongly enrolled in multiple Medicaid or Affordable Care Act health plans. Identifying and stopping this issue is crucial, but HHS needs support from other groups. Health Secretary Robert F. Kennedy Jr. promotes “radical transparency” as a key goal for reform—a great step, but more action is needed.

Currently, tracking waste and fraud at HHS is not a top priority. Every year, the agency announces record fines against fraudsters, but these records get broken again and again. To make real progress, we need more people focused on the problem. Sharing data from these public programs can empower researchers, journalists, and everyday citizens to find and tackle issues more effectively than HHS alone.

One of the first steps should be to reconsider a plan the Biden administration proposed, which aims to limit access to Medicare and Medicaid claims data. This information has helped many experts highlight problems in the system. If access becomes restricted, independent research will suffer, and federal control will increase. Due to public and political outcry, HHS has postponed implementing this plan until 2026.

There’s also a need for de-identified claims data from ACA plans to be publicly available. With advancements in technology, HHS can streamline how we access information about taxpayer-funded programs.

Now, you might wonder about privacy concerns. However, past trends show that scammers usually target data for identity theft, not clinical data. Modern de-identification techniques can further reduce privacy risks. Like it does for the National Practitioner Data Bank, HHS could require researchers to commit to not attempting to identify individuals.

Making data available promotes accountability and can push for improvements in the health care system. Enhanced transparency might also foster public support for future reforms.

Yet, transparency alone won’t solve America’s escalating health care costs. HHS’s best move is to open the market. Lowering barriers will allow for healthy competition, which benefits everyone.

Some ideas worth exploring are:

• Expanding access to generic drugs
• Allowing over-the-counter sales
• Streamlining telehealth regulations
• Easing restrictions on various health care practices

Flexible payment options should also be encouraged, such as health reimbursement arrangements and health savings accounts. Emphasizing market-driven solutions could lower costs, especially for low-income and rural communities.

In summary, prioritizing transparency and accountability while allowing innovation and competition in health care should be at the forefront of HHS’s agenda. True progress happens when data is shared, rules are relaxed, and creativity is invited into the system.

For further insights, you can refer to the reports from reliable sources like Stat News and HHS.

Ge Bai is a professor of accounting and health policy at Johns Hopkins University. David A. Hyman is the Scott K. Ginsburg professor of health law and policy at Georgetown University.

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health care costs,Medicaid,Medicare,Policy