Where to Now? True North Again

By Kevin Mowll, Executive Director of the RISE Association

The failure of the Republicans to repeal, replace, or wreck ObamaCare is a wakeup call for everyone, not just Republicans.  

While the RISE Association steers away from purely political commentary, the lesson of this protracted political mess needs to be called out for the sake of putting our priorities straight around public policy regarding healthcare reform. In the attached Wall Street Journal article, which suggests that bipartisan solutions are the only remaining way forward, the author proffers hope that the blistering truth will be obvious to all the participants in the 7-year-long fracas around repeal and replace. The bloodied players may still brood in frustration that their political wills were not enough to win, but the author wonders if cooler heads will prevail. I, for one, am not so sanguine; yet I can only hope. https://www.wsj.com/articles/republicans-search-for-answers-can-they-find-any-across-the-aisle-1501259286

The lesson I take away from the many years of wrangling is that the ObamaCare political football games demonstrate that political battles of wills are not the way forward. They lose sight of the True North issue at hand. Rather, the failures of both political parties in arriving at a bipartisan solution signals the fact that what is good for America is good healthcare policy, not political prowess over rivals.  

 Governing from the fringe is not sustainable in a democracy. When you examine which Americans will benefit or suffer the most from a proper solution to the uninsured problems and the brokenness of our healthcare system, you come to realize that it includes everyone. The root problems are so vast and complex that politically-based "band aids" are too shallow and glancing to cover over the festering issues that must be combated for the sake of every American. No amount of financial trade-offs between low income subsidies and income transfer politics, nor military-spending (guns or butter economics), will begin to heal the underlying ills that consume 18% of Gross Domestic Product, while coughing up some of the worst healthcare outcomes among developed nations.  

 This is a time for statesmanship, not partisanship. Stand back and look at what drives spiraling healthcare costs. Do not be fooled that it is merely insurance prices. Insurance is only the repriced estimate of future healthcare costs that professional insurance actuaries can divine. They are readers of tea leaves, not creators of the original costs.  

 The True North issue of healthcare in America is that its broken system is a tax on our national economy, a thief of U.S. jobs and a pirate in our pay stubs.  It’s not only the underinsured and uninsured people who require a dramatic fix to the real sources of healthcare cost inflation and rotten value received; it is all of us who deserve it. That is what got lost in the many recent years of bitter politics. 

 Insurance coverage is only the wrapper around the mess that underlies what it covers up. For a down-to-earth sampler of "what's wrong in American healthcare," see my book review of Unraveled: Prescriptions for a Broken Health Care System, by Dr. William Weeks and Dr. James Weinstein (https://risehealth.org/unraveled-prescriptions-to-repair-a-broken-health-care-system). From a macroeconomic perspective, check out the statistics from the Organisation for Economic Co-operation and Development  (OECD) http://www.oecd.org/els/health-systems/health-statistics.htm .  

For a menu of large scale experiments in healthcare reforms, look no further than the CMS Office of Innovation. https://innovation.cms.gov/  Examples include accountable care organizations in Medicare, exercises in transforming our broken fee for service healthcare industry to a pay-for-value-received paradigm, and demonstration programs for dually eligible populations. While none of this is a perfect solution, nor is there a single one-size-fits-all fix, there is a resounding and consistent message: only a population-based healthcare program can prove valuable and accountable for delivering better quality healthcare.  

 In short, population based healthcare cannot reach people who are excluded from the pool. Just like inoculation for a disease, the whole populace must be vaccinated to achieve our public health goals. If major portions of the population are excluded, the whole population is at risk. The dialogue about healthcare reform began before the 2010 passage of Obamacare, and the slogan was, "everyone in the pool!” Here we are again. Let's belly up to the challenge.  

In order to get something fixed for everyone's constituency, every legislator needs to swallow hard and get down to a three-step reform of healthcare. Step one, get everyone in the insurance pool. Step two, change the incentives of the economics for healthcare providers and payers. Step three, transform the healthcare delivery system. In truth, achieving steps one and two will trigger step three. It will be painful. There will be screaming and kicking, but ultimately it will get us out of the bottom of the pack of OECD nations in terms of quality and cost.   

No, wait! Can we aspire to something better than digging ourselves out of the cellar?  Perhaps finding ourselves to be the Pittsburgh Pirates of baseball (apologies to all my friends in Pittsburgh). See http://www.foxsports.com/mlb/gallery/worst-mlb-teams-in-last-25-years-062310. Or should we fix our sights on a higher goal to Make America Great Again?  Hmm.  Sounds familiar, somehow. 

Kevin Mowll

Tags: ACA Marketplace, ObamaCare, Healthcare Reform

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