Successes & Failures of 2016 U.S. Elections — Part 15

DESTINY OF OBAMACARE/ACA AND CURTAILING HEALTHCARE COSTS: (OBAMACAREIII)

by Sunil J. Wimalawansa


It is important to transform our villages and small towns into vibrant, peaceful, healthy, and economically self-sustaining communities.  Similarly, it is crucial to provide them with basic human needs including shelter, access to water and sanitation and nutritious food, education and healthcare.  Fundamental responsibilities in facilitating these remain with the government that is financed by the taxpayers.  Neglect of any of the above will eventually create chaos. 


“What we need are leaders who care enough, know enough, do enough, and resist enough.”~ David Satcher, MD, 16th U.S. Surgeon General.

Destiny of Obamacare: 

( January 18, 2017, Washington DC, Sri Lanka Guardian) There are several areas where Democrats and Republicans can (and need) to set aside their egos and start to work together for the benefit of We the People, and the country.  The goal should be to keep the populous as healthy as possible with minimum expenditures.  Regarding Obamacare, sensible compromises should be made by both Republicans and Democrats, extracting what is good and eliminating the bad from the current care plan.  Everything to-date, indicates that modifying the Affordable Care Act (ACA) with a modernized plan will benefit citizens.

Examples of what should be retained include portability, coverage irrespective of pre-existing conditions, inclusion of children who are not working up to a specified age (e.g., 26-years), plus free coverage for those who are below 50% of the national poverty line through a Medicaid program.  Some of these are important fundamental concepts that are included in the ACA and together with new concepts, should be merged with the “Republican healthcare plan” in part laid out in its website.

Key features of the replacement healthcare plan and approaches to it:

Key features of this should include, lower premiums, universal access, ending junk lawsuits, prohibiting insurers unilaterally cancelling policies, increase market competition by allowing purchase of health insurances across the state lines, promoting healthy lifestyles, allowing dependents to remain in parents’ insurance plans up to 25 years, etc.

Nevertheless, the challenges are not trivial.  Despite the egos and personalities, it is essential to come up with a single, long-term sustainable, replacement plan from among the dozens of individual plans put forward by various Republican Congressional members.  Tinkering and patching the current plan or even the new plan is not the way forward.  The issue is further complicated by the team representing by the president elect having proposed its own replacement plan, separate from the Congressional plans (Trump administration new healthcare plan).

Perhaps one of the ways to resolve this is for the key Congressmen from both the senate and the House with the input form the Trumps team, to engage in working retreats over weekends, to advance and finalize a united replacement plan to replace Obamacare.  Without such a genuine attempt, just casual discussion between rival plan holders with vested interests will take it nowhere.

What type of healthcare is appropriate for the United States? 

Click on the image to read the previous parts of this series

The new administration has a great opportunity to revolutionize and strengthen the healthcare delivery system in America for generations to come, especially by focusing on disease prevention, rather than expansion of disease treatment.  Increasing spending money on hospital-based and specialized treatment centers, would be glamour politically, but would be putting the money into a bottomless pit.

This is a unique and a rare opportunity for the new government to create a comprehensive, health plan that is near to a universal health system.  This concept is closure to the visions of Mr. Trump and the democrats.  Therefore, if Republicans are not being too dogmatic, their willingness to being flexible will allow them to make a bipartisan agreement in creating the new bill.  Under the current prevailing issues, it would be the best way to provide the most cost-effective healthcare to maximum number of people in the United States.

Currently, little attention is paid to prevention, and most of the healthcare costs are going for treatment; this must be changed.  Thus, a paradigm shift of striving for focused, chronic disease management program should be included in the new plan with the focus on keeping people healthy.  The plan should encompass rigorous evidence-based, best practices to accomplish long-term, cost-effective system with easily measurable clinical and economic outcomes.  Such a comprehensive approach/plan, which would decrease significantly the cost of U.S. healthcare while improving the quality of care.

This approach should be targeted particularly for groups that consume a greater share of the healthcare services and costs, such as the Veterans Administration, older adults, and those with chronic diseases and terminal illnesses.  These sectors consume more than 80% of the country’s healthcare and the cost.  In addition, it is important of the federal government and the Center for Medicare and Medicaid Services CMS to have formal negotiations with all pharmaceutical companies to set up price limits, perhaps comparable to the prices that they sell in Canada.  Using Canadian price as the benchmark would be the easiest solution to controlling the escalating sots of medications and devices.

The consequence of the lack of priority, incentives, and funding allocation for prevention of illnesses is that the costs associated with chronic diseases continue to escalate.  Unless the new system comprises legalities to prevent such waste, it also will fail.  What the country needs is to nurture and promote a nationwide, harmonized, community-based, effective primary care center system that provides primary and secondary disease prevention programs aimed at keeping people healthy.

Curtailing the costs of healthcare:

The incentives given must be shifted from acute hospital-based (specially) care to disease prevention (i.e., keeping people healthy).  By adopting such measures, one can be assured that all segments will get the best of care and choices at the least cost.  The use of robust outcome metrics for effective care management for these vulnerable segments is expected to reduce healthcare costs while improving care.

The current healthcare system in America is the most expensive in the world but not the best.  It is not necessarily the drugs and investigations that escalate healthcare costs but the built-in tremendous waste; this must be removed.  The current system is based primarily on financial incentives provided to deliver expensive, specialty-driven, hospital-based treatments for a few diseases, most of which could be prevented.  But working together, we can reverse this within the next few years.

The importance of widening the net for healthcare insurance in the U.S.:

The Accountable Care Organizations (ACOs) that were established under the Obama administration have failed their mission in some aspects; they provide healthcare for only approximately, 9% of the U.S. population.  Mere expansion of ACO coverage and insurance does not necessarily mean having better healthcare for citizens.  Any healthcare model, including the ACOs, that fails to address disease prevention, wastage, and pilferage, would be a waste of taxpayers’ money and will not be successful in delivering cost-effective healthcare in the country.

A model based on prioritizing disease prevention and keeping people healthy would improve significantly the quality of life of all Americans.  With a reduction in sickness, absenteeism from schools and work (i.e., keeping people healthy) decreases and productivity improves so that the overall cost of healthcare would be expected to decrease by at least 30%.

Moreover, such approaches negate the need for building new expensive hospitals and networks and reduce the need for expensive drugs and procedures. Keeping Americans healthy means fewer medications and hospitalizations, reduced opportunity costs, increased productivity, increased longevity, and greater satisfaction and happiness.  It is also likely that the name of the new plan will be changed from the current one so that it can be identified as a new non-political entity (not Trump-Plan or Ryan-Plan, so something like that).

Tinkering with the current system, changing the name of Obamacare just to demonstrate it is a new system, and having multiple levels of insurance that add no value but add cost to the system would not help the public or the country.  Therefore, it is a no-brainer that unless these healthcare issues are addressed properly using out-of-the-box thinking, a paradigm shift, by the new administration, one cannot envisage tangible improvements in delivering a cost-effective healthcare system.

To be Continued


Professor Sunil J. Wimalawansa, MD, PhD, MBA, DSC, is a physician–scientist, social entrepreneur, educator, and philanthropist, with strategic long-term vision.  The author can be reached via wimalawansa.org 


 

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