How to Fix U.S. Healthcare By Gilbert Lawrence

How to Fix U.S. Healthcare By Gilbert Lawrence

America recently witnessed the debacle of the American Health Care Act (AHCA) seven years in the making. The plan was developed by House Republicans led by a physician Congressman from Georgia who practiced orthopedic surgery, Dr. Thomas Edmunds Price, now President Trump's Secretary for Health and Human Services (HHS).  

From scenes in Congress, and prior to that in town-hall meetings all across the country, it is abundantly clear that an area of most concern to ordinary folks irrespective of their state and political party affiliations is the fate of their healthcare. It is also clear that both parties are deadlocked within themselves and with each other on approaches to tackle the problem.

Identifying the Problem

The truth is healthcare is too complicated and too important to be addressed and monitored by politicians; however well-meaning they may be. What is more important, health-care and its spiraling costs are too dynamic for politicians to dabble every two or three years.  

Healthcare has to stop being a political football or a buffet smorgasbord that American corporations (Insurance carriers, pharmaceuticals, hospitals, bio-tech corporations) can feast-on. Health-care consumes 19 percent of the country's GDP which is 30 to 40 percent more than in other advanced economies. 

Beyond the talk of fiscal responsibility and government's role, the likelihood is the politicians are merely fronting various corporate interests while using health care of Americans as pawns. One just needs to follow the campaign contributions and messaging from PACs on TV and radio. 

The Affordable Care Act (ACA) addressed payment for healthcare with the primary goal to provide coverage for all. As a first step, the goal was fulfilled with mechanisms to insure all (at least on paper) with a lot of assumptions of numbers involved and with cost-shifting among the various demographic and socioeconomic groups. 

Insurance companies and their lobbyists encourage politicians to discuss payments systems including high-risk pools, to pay for rising healthcare costs.  But that is not where the problem is or should be. Many studies show that for a variety of reasons, a third of healthcare cost is over-utilization of healthcare resources and outrageous charges.

The more difficult aspect of healthcare (both in America and across the world) is annual spiraling costs of healthcare. Unfortunately after addressing one part, President Obama and his HHS Secretary failed to address the other half of the two-sided coin.  After ACA became law, discussion of healthcare delivery models (Cleveland Clinic, Mayo Clinic, Kaiser Permanent, Colorado models) disappeared from national political discourse.

Health insurance companies took advantage of the political chaos and gridlock in Washington, DC and elected to pass-on the increased costs of healthcare to the policy-holders along with their overheads (including Mergers and Acquisition) and profit margins.  Pharmaceuticals, biotechnology and Medical Devices companies got into the act hijacking their prices.

Any healthcare payment system is doom to fail if it is not coupled with healthcare cost constraints.  Hoping to use the individual person or patient to take on the healthcare insurance industry or hospital, pharmaceutical, other industries and trade association to somehow control healthcare costs is just not tenable to put it mildly.

Addressing the Problem

For President Trump along with Republican and Democratic leaders both in the House and Senate seeking a way to address their voters' wrath and get on with the job of governing, the easiest option is to appoint a blue ribbon panel to come up, within 6 months, with a healthcare system which will provide accessible and affordable healthcare for all Americans.

Based on demographics, every region (a state or region within a state) needs a healthcare budget; which sets the fiscal boundries for all principles (insurers - including Medicare and Medicaid, employers, consumers, various direct and indirect providers) to work within.

Developing a health-care budget based on population and other ancillary factors (like predominant occupation) is not rocket science. It is standard practice in several situations in this country as well as in health-care systems in all advanced economies.

Developing an affordable and accessible healthcare delivery system does not need developing a new system. It does involve adapting already existent health delivery systems which exist in pockets in the USA and nationally elsewhere in the developed world. The principles of medicine and delivery of healthcare are the same. Comparative population-based healthcare studies permit patterns-of-care and outcomes data which is the key to improve quality of care and reduce costs. 

However well-intention the practice, Medicare and Medicaid need to end cost-shifting.  This has been the gateway for hospitals and corporations to shift costs in other situations; thus creating a host of shenanigans which few can follow or understand.  A classical end-result of this practice is the $15 hospital-charge for an aspirin tablet. 

Washington politicos could provide voters immediate relief with some low-hanging fruits:

1.  Permit drug importation from Canada, Europe and American-certified foreign pharmaceuticals;

2.  Allow Medicare to negotiate drug prices for seniors; just like the VA does for its members;

3. Pass Medical malpractice and Product-liability reform.



Gilbert Lawrence is a M.D. in Utica, New York.

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