What Trump’s healthcare plan should, and shouldn’t, do
If healthcare organizations have gotten good at anything over the last few decades, it’s adapting to unrelenting change, such as that likely to proceed from the election of Donald Trump.
It’s apparent that change will be coming in healthcare. It appears that Republicans now have the numbers to do whatever they want to the Affordable Care Act, and no longer have a Democratic president who will stand in the way of attempts to change or repeal it.
There are many healthcare issues that have increasingly afflicted the nation over the past 30 years, and they won’t magically disappear under a Trump administration. We know them all too well:
- Rising numbers of Baby Boomers who are now or soon will be covered by Medicare.
- Still too many millions of individuals who are uninsured or underinsured (and the question of whether those ranks will increase if ACA is repealed or drastically altered).
- Incredibly massive national expenditures for healthcare that nearly consume 20 percent of our gross national product.
- Out-of-pocket medical expenses for consumers that can far outstrip their ability to pay for them.
- Providers who are struggling to make it financially, and fear the prospects of potential increases in uncompensated care expenses if fewer people have healthcare insurance coverage.
It’s against this backdrop that the Trump administration, and Congress, will act. It is as challenging and complex an environment as any incoming presidential administration has faced since the creation of the Medicare program.
Even as much remains unknown, there are a couple of truths that should, and likely will, guide any rational administration direction in healthcare:
- While the coverage mechanism may not be ACA/Obamacare, we cannot and should not roll back to an approach that leaves 40 million or more Americans without health insurance. This leads to unmanaged and expensive care, and puts at risk millions of Americans who, in the current American economy, no longer have traditional employer-sponsored healthcare insurance. Healthcare costs not covered by insurance don’t just evaporate—they are borne by everyone and thus become a de facto national healthcare system.
- Work must proceed on efforts to realign incentives in healthcare reimbursement to achieve a healthcare environment that we all probably would want—one that optimizes health to the greatest extent possible, and that helps deliver care as early in disease processes as possible, as effectively as possible, before conditions become critical and treatment options become expensive. Becoming a smarter, learning healthcare system will require the application of more IT, and emerging forms that hold promise, such as artificial intelligence.
- Providers must be supported as they move from pay for volume to pay for value. The transition must be accomplished quickly and decisively. The broad provider community will need to do its part by streamlining operations, reducing needless expenses (read, administration) and more cheaply delivering care.
There are many other components for reducing costs, but any successful effort must look at big increases in efficiency and cost restraint, since the demand side of the equation is likely to continue to rise for the foreseeable future. The use of IT, therefore, is of crucial importance in achieving true reform.
Finally, after a brutal primary season and campaign, the nation must find a way to come together with a commitment to unity to solve problems, not the continued polarization that has characterized American politics for the past 20 years.
For those whose candidate wasn’t elected, don’t despair. I’m reminded of the words of Luis Rukeyser after the Black Monday stock market crash of 1987, calling for investors to not lose perspective, invoking that "The robins will sing; the crocuses will grow; babies will gurgle; and puppies will curl up in your lap and drift happily off to sleep, even when the stock market goes temporarily insane." America’s been made great by wrangling through conflict, and this is a time to improve the country by engaging, not withdrawing.
For those whose candidate was elected, don’t gloat. There’s no monopoly on having one right solution, and navigating the many problems encumbering our nation—more than just healthcare—will take all hands, in an inclusive, participatory democracy. Governing also mandates responsibility, and it is a grave responsibility at this point in the life of our country.
The election of one candidate is not an end unto itself, but rather the beginning of the process. We need each other to truly make ourselves all we can be as a country.