Although the current law is fraught with problems, in some important respects, it is actually doing its job. Witness the fact that tens of millions of previously uninsured Americans who were getting their primary care in the ER (if they were getting care at all) now have coverage that encourages them to get medical treatment in a more appropriate (and less costly) setting. The payment system is changing from a pure fee for service model to one that actually requires (and incentivizes) healthcare providers to be financially accountable for health outcomes. We’re beginning to make smart bets on preventive medicine. People with “pre-existing conditions” are no longer denied coverage or disadvantaged by higher rates for coverage. There are no longer lifetime caps on payments for care. And, despite what many would have us believe, the rate of growth in healthcare expense is actually trending DOWN since passage of the ACA, not the other way around. (In the 10 year period preceding ACA, healthcare expenses rose by an average of 6.91% annually, whereas in the 6 ears of reported experience since passage of the act (2010-2015), healthcare expenses have risen by an average of 4.27% annually.)
Much remains to be done, though. There needs to be greater patient accountability and investment (yes). Whether through tort reform or other means, healthcare providers should be enabled to practice good medicine without having to practice defensive medicine. The U.S. must adopt better ways of managing and dispersing its drug discovery costs, and payors should have better ways of negotiating drug costs. IF we’re going to continue to avoid a single-payor option, we must find ways to expand the marketplace for coverage. At the end of the day, we’ve got to achieve better health outcomes thru a less costly system. Our “American exceptionalism” in this respect isn’t impressing anyone. What we don’t need to do, though is throw the baby out with the bathwater.
We DO need to have a national conversation about healthcare - In a post a few weeks ago, I suggested that we might be better off as a nation having fewer conversations about race, saving our time and energy for action rather than talking. Unlike the ‘race room’ in our house, where the conversational carpet has been worn threadbare, the carpet in the ‘healthcare room’ is practically new, and it’s got a big purple mama elephant and her newborn standing on it. Perhaps we should have a chat before one of them drops something on the floor.
A grownup conversation, where we answer once and for all the question, “Is healthcare a right in this nation, or is it something less than that?” Add to that some serious discussion (not hand-wringing and name-calling) for a change about the single-payor option. And, if we’re going to allow fellow citizens to voluntarily “go naked” on coverage, should we revisit laws that require hospitals to treat them as though they were indigent?
Before we just totally jerk the nation’s employers, the primary providers of privately sponsored healthcare coverage around again, we should weigh the burden that we’re asking them to absorb… like the fact that in covering the lion’s share of the expense for privately-based healthcare in the U.S., our businesses are forced to deal with a significant cost overhang that none of their foreign competitors has. That’s a serious competitive disadvantage, and a heavy lift.
We should extend that conversation to health information. Who does it belong to, how should it be safeguarded, and once and for all, please, how can we better utilize it? I’m not wild, for example about the “Preserving Employee Wellness Programs Act”, federal legislation that would, among other things enable companies to access private genetic information for employees and their family members.
Do your part - Pardon the sermon, but this is a matter where it is in everyone’s best interest to let citizenship take priority over entertainment. If you aren’t yet impeccably well informed about the healthcare debate, get that way, soon. Look, I know it’s Spring, the flowers are blooming, trout are eating bugs off the surface, March Madness awaits, and all that, but this is important, to you and the people around you.
Do your homework. Read the legislation… It’s boring, I know. I’d rather drink a half-gallon of cold MoviePrep at 4AM and go get a colonoscopy than read the proposed healthcare bill but I’m going to read it anyhow. You should too. Ask tough questions of legislators, regardless of which side of the aisle they are on. Talk with professional association representatives. Ask your physician what they think needs to be done with our healthcare system. I did, and wound up having a very informative forty-minute conversation with someone whose opinion I already trust with my life. Please. Just. Do. It.