The GOP, with the leadership and guidance of President-elect Trump, are going to have their hands full fixing healthcare. Similar to the Democrats in 2010, they will have a great opportunity with limited roadblocks (other than the need for a supermajority in the Senate). With this opportunity comes the responsibility to get it right.
I would give the Democrats an “A” for effort, but a failing grade in executing President Obama’s signature legislation. And to a large part, I attribute this to partisanship arrogance. The party of ‘hope and change’ didn’t stay focused on what has worked to make our country great: the democratic process. To achieve sustainable, sound healthcare, the Republicans should work first on building consensus. Even though they are the party in power, it is important to understand the short-term nature of this power which led to a legislative stalemate once the balance shifted.
I believe everyone in the United States should have access to quality healthcare. The Affordable Care Act got a few things right. There should be no pre-existing condition exclusions and no lifetime maximums. There should also be essential benefits which every American should be guaranteed.
Well thought-out change
This system should not be government-run. The Veterans Affairs healthcare system and Medicare funding paralysis gives us a very sharp focus on the future if government is in charge of healthcare. The voters in Colorado also gave us a glimpse of the people’s opinion. The government can be a good watchdog but they are not a good operator. The political process is not conducive to best medical practice or to low costs. Government inefficiency, the impact of special interests, and political posturing will drive low quality, high costs and stifle innovation. In my view, the best government-sponsored healthcare is the Medicaid system, which is state-run and largely private sector-based delivery. Yes, we need to work on eliminating fraud, but Medicaid is leading the way in innovative pay models, aligning payers with providers in controlling costs, and encouraging best practices in care delivery.
The exchanges, whether state or federally-sponsored, should be blown up. This system created administrative cost bloat and did nothing to simplify healthcare or reduce costs. Instead, more effective Medicaid expansion should be coupled with a much more punitive individual penalty, which should be structured similar to Medicare: progressively increasing the premium for failure to obtain timely coverage and a once-a-year open enrollment.
The employer-based system should be retained and expanded. It is far easier for the government to enforce and monitor coverage compliance through employers than with a purely individual system. Limiting the employee exclusion for healthcare premiums would also be a bad idea. It will force all employers into a lowest common denominator plan worsening healthcare for all.
The system should focus on transparency. The profits in pharmacy are unconscionable. More should be done to reduce oversupply and encourage efficiency in hospitals. And there needs to be greater connection between payers and consumers of care.
I don’t think healthcare utopia exists anywhere in the world. American healthcare can be great. It just needs some well thought-out change.
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