As I write this, the news is breaking that the American Health Care Act has been pulled from the floor late on a Friday afternoon and we’ll have to wait and see what’s next for healthcare in America. I was originally asked to put together a piece comparing the Affordable Care Act (Obamacare) with the AHCA. Perhaps now would be a good time to step back and reflect on how Obamacare actually changed our healthcare environment, and why the concerns about simply “leaving it well enough alone” or “letting it collapse under its own weight” are valid.
In my opinion, Obamacare was never meant to be a sustainable platform. It was designed to do exactly what it has been doing … make the process of government-mandated healthcare so bloated, so much more expensive, so complicated, and so unsustainable that the private insurers (who signed on to this with greedy, shortsighted deals with the devil looking at the promises of millions more new customers and Candy Land promises from Uncle Sam that they’d be taken care of) would no longer be able to provide affordable coverage. As a result, they’d pull out, and then Uncle Sam would have no choice but to step in and sweep all this up into one massive, intrusive, all-encompassing superpower of an intractable entitlement that has been at the very top of the liberal progressive wish list for decades. For those who believe that the people are better served when there is a competitive marketplace, Obamacare’s design is the very epitome of evil genius.
What’s happened in the past 20 years or so is that the drumbeat from these progressives has now become widely accepted as fact — that cradle-to-grave, government-paid healthcare is a birthright of every American (and, to be even more provocative, everyone who lives in America, whether here legally or not). Meanwhile. some of us have been saying, “Be careful what you wish for,” because while rising tides lift all boats, so too do sinking ships drown everyone who doesn’t throw themselves overboard.
Widespread sharing of worst-case scenario stories has caused the average American to believe that having a health insurance card — any health insurance card at all — in your wallet is more important than access to quality and affordable care for all Americans. This is how entitlement starts, and this is why the idea of a full repeal and replace may sound good to some but will be nearly impossible to do.
Do we want to make sure that every American has access to affordable, quality healthcare, or do we want to make sure that they have an insurance card?
This is the question that Obamacare and its supporters never once stopped to answer. The promise of a government-paid, no-limit “Obamacare healthcare credit card” was dangled in front of everyone’s eyes, and a lot of smart and difficult questions were never asked, much less answered, in the rush to get Obamacare to pass at long last.
If I were advising President Trump (which I am not), here are two key ideas I’d suggest exploring:
We need to have a brutally honest but compassionate dialogue with the American people about what healthcare is and what it is not.
As big and complicated as the healthcare universe is, it has been successfully compartmentalized in the average American’s mind as government-paid doctor and hospital visits. It is much larger than that, including a patient’s own responsibility for taking ownership of their own health and that of their family. Many private insurers, pharmaceutical companies and patient advocacy groups have been working hard at shifting the thinking from sole focus on critical treatment of sick patients to mitigating behavior or lifestyle that can prevent the disease state from progressing in the first place.
Educational programs for targeted populations who are genetically predisposed for diabetes, for example, have been very effective in helping families adjust their diets and lifestyles and be more aware of their glucose levels. Identifying early genetic markers for some cancers has helped patients be more diligent about getting screenings and become aware of what lifestyle factors they can address to stay on top of their own health.
These days, it is almost more common to find a Fitbit or other kind of fitness tracker on a person than not. These kinds of activities and programs are exactly what the doctor ordered, so to speak, for the general public.
The bottom line is that if you are relying on the government to provide you with healthcare, you shouldn’t be the slightest bit surprised when the government then thinks that it can dictate how you live, what you eat and how you spend your money at the grocery store. Unfortunately, there has been a mantra that has been accepted by too many Americans that the government knows better than they do about how to help them fix what ails them. This is one reason why the prospect of taking away something that the American people think they’ve already been given, regardless of what the value of that thing actually is, is so toxic to the prospect of any meaningful dialogue.
This is a context switch that will take years, not months, to effectuate. Just because it will take time doesn’t mean that it won’t have value; and even if it can’t change votes or minds in a short enough timespan to impact the future course of the government’s involvement in healthcare doesn’t mean that it shouldn’t be attempted.
We need to stop devaluing quality care in the patient’s mind.
When a patient’s only financial concern when they go to a doctor is “How much is my copay?” there is no reason to care about what’s behind the rest of the bill that goes to their insurance company. Similarly, a price point is then set in their mind that “an office visit to a doctor should cost me about $20.” When one Senator suggested that Americans should perhaps start thinking about healthcare as part of their budget in the same way that they think about whether or not they should upgrade their iPhone, he was, predictably, pilloried as an uncaring, out-of-touch bad guy who was telling poor people that they didn’t deserve a new iPhone and healthcare.
If Americans were treated as the proud, strong, self-reliant people they should want to be, then we’d all have healthcare savings accounts, and could decide which care we need and which provider or course of treatment makes the most sense for our budget. That power of the purse would then force healthcare providers to compete for that business and try to offer more value to the patient, better customer service and more meaningful interactions with their patients that could lead to better outcomes.
Health insurance, like every other kind of insurance we purchase for ourselves and our families, was never meant to cover every single health expense that a human being might incur as a result of, well, being human. It was meant to provide a catastrophic safety net in case of injury or illness that would otherwise be financially ruinous to the individual. Going to the doctor to get a prescription for an antibiotic when you get an infection would be a lot more reasonably priced if the weight of the health of the entire ecosystem weren’t aggregated by actuaries and spread across every transaction for everyone, regardless of health.
There is simply no ideologically pure way to address the healthcare issue. The government genie is out of the bottle and cannot be withdrawn without dire ramifications for any politician who proposes it. What needs to happen now is an acknowledgement that the government and, therefore, taxpayers are on the hook for providing something, whether we like it or not. What that something is, how those dollars are spent and the return on investment of those dollars (hopefully a healthier U.S. population with better outcomes from disease treatment) should be the focus moving forward.
About the author: Kelly Moore has sold clinical research and development software solutions to the pharmaceutical and biotech industry for the past several years. She previously spent 20 years in business development for the pharmaceutical R&D field, focusing on multi-study, global clinical programs. She has a bachelor of arts degree in Economics from the University of Texas.
Any opinions expressed in this article are strictly her own and are not meant to represent those of any employer, client, or organization with whom she is affiliated.
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