This conservative changed his mind on universal health care. Kansas can lead the fix

Joseph Taylor
·3 min read

I’m not necessarily a 100% committed Republican. I did vote for a Democrat once. But I also identify as an amateur statistician, financial analyst (with an MBA in finance) and economist (with a bachelor’s degree in economics), and I have a certification as a Lean Six Sigma Black Belt. So facts matter a lot to me.

The fact is that our current medical system isn’t working very well. While we might prefer a free market solution to most challenges, health care may fall into the same economic space as progressive taxation, public goods and natural monopolies — areas where it makes good sense, even for conservatives, to consider alternatives to the free market.

But reworking our entire system would be extremely difficult. It makes more sense to make intelligent changes where we can, testing each change to see if it makes sense. The ideal solution would be for individual states to make changes and serve as examples of what to do for other states. Of course, if the state succeeds, it would be known as a leader. Failure would result in derision and mockery. (This is why California should implement full-blown socialized health care. Please, go for it. Just do it. I really want to see how it works out.)

Kansas, though, has an opportunity to start small and do something right. Let’s fix pharmaceuticals. Congress has messed this part of our system up so badly it’s crying for reform.

First of all, we need to be clear that how drugs are prescribed and priced today is not the free market at work in any sense. Congress has colluded with insurance companies, the pharmaceutical industry and the PBMs — pharmacy benefit managers, middlemen agencies that manage prescription benefits for insurers — and together, they have literally legalized kickbacks. This system has made competition illegal, creating a system that generates enormous profits for the major players. We can fix this.

To my conservative friends: I agree that the solution to bad government isn’t more government, but I’m suggesting that the solution to bad federal government may be better state government.

Here’s what we can do: First, Kansas should start by establishing a state-run pharmacy benefit manager offering direct sales online. Second, this agency should create a formulary — a list of drugs available to be filled in prescriptions. Third, allow anyone to buy from that PBM. Of course, discounts for volume purchases from retailers and pharmacies would apply. Fourth, the program should be required to make a profit and not be subsidized by taxpayers. So, it would operate kind of like a utility.

We might even allow people who don’t live in Kansas to purchase from our PBM. I suspect it would be very popular and could generate hundreds of jobs here in the state.

I know there are significant, serious barriers to getting this done. The federal government would not want to cede its authority, but that’s why we have a state attorney general and elected representatives.

Making a Kansas pharmacy benefit manager budget-neutral would be hard, but doable. The existing PBM/pharmaceutical industrial complex would fight it with all their might — but again, that’s what our attorney general is for.

This could be a great time for Kansas to lead in creating an intelligent, fair solution for a small part of our medical system.

Joseph Taylor of Overland Park has resided in the Kansas City metropolitan area for 40 years. He spent decades working in information technology, including writing medical billing software.

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