Why the healthcare debate is the enemy of healthcare reform
With a sigh of relief from many, the Lindsey-Graham bill attempting to fast-track a repeal of the Affordable Care Act died a quiet death this past week.
Ah, but there’s never a final nail in this coffin. It’s really not dead. A simple perusal of recent news stories proves that.
Within a couple days after the announcement that the Senate wouldn’t consider the bill, by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, Bloomberg News reported that the congressmen met with President Donald Trump to discuss a plan to revive the legislation in the coming months.
Meanwhile, the Trump administration is reported to be taking actions that appear to disrupt the Affordable Care Act, with Bloomberg again reporting that top federal officials have been told to not assist states in signing up Americans for Obamacare insurance during the upcoming enrollment period. That, and other administration efforts, have the end result of driving up health insurers’ rates for enrollees, and insurance rate increases then are used to support the narrative that the program is failing.
It’s not that a bipartisan effort can’t succeed at the federal level. I was encouraged to hear that Republican Senator Lamar Alexander of Tennessee and Democratic colleague Patty Murray of Washington are close to an agreement on a bipartisan package to help stabilize Obamacare’s individual insurance markets—both head the Senate’s committee that’s responsible for health. Ring the bell—this was only one day after the Graham-Cassidy bill bit the dust. Notch one for legislators trying to do something, reaching across the aisle, to aid the American people.
It’s easy to get mired in the politics of this battle, and your perception of the fight depends on whether you believe Obamacare is completely misguided or is the target of blind-hatred attacks. However, if all this boils down to a political firefight, then it will end up being a complete waste of effort and attention, no matter which ideology eventually wins out.
For providers, consumers and American businesses, fixing healthcare is not an ideological confrontation. The discussion truly needs to be about fixing a broken reimbursement system that’s in need of massive attention. Most everyone knows that new incentives are needed to increase healthcare’s value to everyone—particularly those getting the care. Everything should be done to increase efficiency, improve patient safety, determine the best treatment approaches and engage everyone in the industry—as well as the patient—in optimizing health.
Partisan battles over who pays for healthcare and playing with dollar figures in legislation don’t do that. That bickering just sucks all the air out of the room. If the battle becomes whether a Democratic or Republican version of health reimbursement ideology wins, we are truly sunk, because that’s just misdirection from the really hard work that needs to be done.
Many organizations in the healthcare industry are ready to move ahead on bold new forms of healthcare delivery. Frankly, I’ve seen things happening in the industry that I didn’t believe were possible 10 years ago—almost all hospitals, and the vast majority of physician practices, are using electronic health records, for example. There’s a renewed emphasis on engaging patients in their care, after decades of discouraging them from worrying about their health. Insurers and providers are working together to share data and records on patients, collaborating to make care cost-effective.
These kinds of efforts can push costs down and make healthcare better, and that’s what we ought to care about. Americans are competitive, so how can we not be enraged by the fact that we are spending so much per capita for care, and yet wind up being in the middle of the pack of developed nations when it comes to care quality and cost effectiveness?
Health Data Management regularly runs stories about how information technology enables improvements in healthcare. Whether analytics head off the worsening of an emergency patient’s condition, or telehealth helps get care to a patient earlier, or information exchange supports faster and less wasteful treatment, these are all vignettes of possibilities. More than IT is needed, to be sure, but these systems and the data they provide can be a powerful tool to support real change.
All these small battles won in research can become something that wins the war—if it’s allowed to happen.
I get it that few want to get involved in the nuances of retooling the system and the research that could support true healthcare reform. We have iteratively gotten ourselves into this mess—but with a grand vision for healthcare and many small victories in supportive research, we can get ourselves out of it.
Lost in this current partisan hate-fest that is healthcare talk in Washington is the bottom line. This affects people’s lives. Not just sick people’s lives—all of our lives, all of our pocketbooks.
Healthcare expenses don’t vanish just because Medicaid is slashed or because insurers handle rising risk by pushing up insurance rates. Patients who show up for care at an emergency department because they have no other care option are being treated in the most expensive care setting, and that cost doesn’t just evaporate into the ozone. It’s passed on to all other payers—which, in the end, is us as Americans.
Really, the only question is whether we choose to construct an effective, efficient system that delivers the best possible coordinated care in the least costly setting. That is something that we are a long way from, and that could use all the time and attention that Washington can muster.