HIT Think

Why healthcare reform must still be addressed

With the decision by the GOP to pull its healthcare reform bill on Friday, the industry now enters the nether world of governmental inaction.

That is not the best of news for healthcare organizations, which have struggled to make sense of the nation’s direction after the Republicans swept to power in November. And that lack of direction could affect efforts to increasingly use healthcare information technology that was widely implemented over the last 10 years, at significant cost and effort.

In a stunning week of political intrigue and dealing, the effort by the Republicans to make good on their promise to repeal the Affordable Care Act, widely known as Obamacare, disintegrated on the public stage on Friday.

For supporters of President Obama’s signature healthcare law, it was a moment to enjoy and even gloat. Meanwhile, President Trump, in announcing the decision to pull the legislation, cast an ominous tone, suggesting that he was walking away from healthcare reform all together, just waiting for the existing program to fall apart. "I've been saying for the last year and a half that the best thing we could do, politically speaking, is let Obamacare explode. It's exploding right now," Trump said, in making the announcement.

That is one of the glaring, gaping problems the nation has faced in trying to grapple with its healthcare ills and trying to find a way to fix them. It has devolved into a political football, beat like a piñata by two political factions that have diametrically opposed world views of the role America should play in managing—or not managing—care in this country.

The result is two parties that wouldn’t think of supporting the world view of the other, preferring a highly polarized and contentious debate. The scope of the challenge can be seen in the type of bill that the GOP offered after trying for seven years to repeal Obamacare—the guts of the proposed legislation was widely panned by healthcare industry groups, senior citizen associations and other organizations with an interest in healthcare.

That’s because the bill wasn’t a healthcare bill—it was an attempt to make a statement on the role of government in healthcare while repurposing expected savings to fund other portions of the Trump administration’s overall plan for the country, particularly tax reform. The fact that it wasn’t a healthcare bill could be easily seen in the crazed negotiations to get the conservative Freedom Caucus to support the bill. Toward that end, the GOP was willing to throw funding for maternity care, behavioral health and hospitalization under the bus, a tactic that eventually—and thankfully—failed.

Now, Trump and the GOP will focus attention elsewhere, meanwhile doing little to help Obamacare, and perhaps taking steps to support its demise. That lack of action isn’t any better than trying to ram through a bill that was more based on economics than it was on healthcare reform.

Because at the end of the day, if Obamacare explodes, it has the same effect as if the GOP bill passed. That will leave millions without healthcare coverage, and healthcare providers across the country again will be holding the bag for uncompensated care.

Of course, it’s all of us that will be saddled with a broken system. When 45 million to 50 million Americans didn’t have coverage, their medical expenses didn’t magically evaporate. We all, as a country, carry those burdens as costs are shifted and passed on to those who have coverage, including beneficiaries of Medicare and Medicaid programs. While they may not show up as a line item on a federal budget, they are nonetheless there.

Last week’s Congressional meltdown should demonstrate that the time for partisan politics in solving healthcare’s ills should end immediately. There have been rising calls for Republicans and Democrats to work together to discuss meaningful healthcare reform. The fact that the Republican party could not draw support from within its ranks to do something it promised for seven years should be proof enough that bipartisan efforts are the only way forward.

Democrats have never claimed that Obamacare is perfect, and they appear willing to reach out across the aisle to address the problems. Any efforts at healthcare reform would likely need mid-course adjustments—why not start where we are now?

This, of course, trivializes the deep philosophical divide that separates the two parties. But at other times of national crisis, the two parties have found ways to work together for the good of the country.

It must be recognized as a crisis when the country spends nearly 20 percent of its gross national product for sick care, and despite those trillions of dollars, achieves a level of care that’s worse than that of many other developed countries. It is a crisis, or even a travesty, that we invest hundreds of billions in information systems to streamline care, and yet hundreds of thousands die from medical errors, from sepsis, from the inability to share medical information.

True, IT is only a subset of the solution, but we have integrated delivery systems, such as Kaiser Permanente and Geisinger Health System, that have managed to parlay technology and new approaches to care delivery in ways that cut costs and improve members’ health.

It’s long past time to end the political divisions over care, come to a consensus on improvement and make it happen. We can agree on a Cancer moonshot—why not a sepsis moonshot? Why not a medical error moonshot? Why not a moonshot that emphasizes the optimized health of all Americans?

The GOP plan failed because healthcare is highly personal. Trimming or scaling back insurance coverage may mean that I die, you die, your family member or friend dies. It’s not just about saving a buck or making a philosophical statement.

Really, the nation decided that the federal government would play a role in healthcare 50 years ago, when Medicare became the healthcare plan for the golden years its citizens. Let’s have the government play a helpful role in making healthcare the best it can be for its citizens, not the blackest hole that they can fall into.

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