Successes & Failures of 2016 U.S. Elections — Part 16


by Sunil J. Wimalawansa

If it is not good for one, it is not good for all; if it is not good for everyone, it is not good at all.

“ Plan all the way with the end in mind.  Taking account of logistics, consequences, threats and obstacles, alternative approaches, and ways to navigate these hindrances.  By planning towards the end-game will minimize surprises, overwhelming situations, and allow one to carry out the project or implementing a law seamlessly.” 

The goal of a healthcare system in the United States: 

( January 18, 2017, Washington DC, Sri Lanka Guardian) The goal of the provision of healthcare insurance in a country, such as national health insurance or Obamacare, should be to keep the populous healthy and productive.  That cannot be achieved by insurance companies preventing patients from seeking services (e.g., imposing restrictions and preapproval processes, etc.) or by “controlling” how physicians practice medicine.  Such would be counter-productive; failed control systems should be a thing of the past.

Moreover, in the real world of compassionate capitalism, there is no place for deductibles in a healthcare insurance plan.  Because of high deductibles many patient wait until they are very sick and go directly to emergency rooms.  This makes difficulty to treat them, markedly increases healthcare costs, and negatively affects their long-term health and productivity.  A lose: lose situation.

There are two key ways of managing healthcare.  First, the outmoded system as practice in the United states; fee for services with traditional healthcare insurance systems.  This scheme is driven by profit making mode with application of restrictions for the beneficiaries and the providers at various levels to control cost and increase profit.  Second, relying upon encouraging and keeping people healthy.  Restriction in healthcare has no place in the latter.

In a system designed to keep people healthy, encouragements and incentives are directed to individuals (including recipients of healthcare and healthcare providers) keeping individuals healthy.  Two systems are fundamentally incompatible. Insurance company lip service and mailing letters to patients suggesting certain options, as done now just to fulfil the regulatory guidance, would not facilitate keep people healthy.  Eventually, the model geared to keeping people healthy would be the most cost-effective and productive.  To achieve this honorable goal, real, tangible actions and encouragements such as incentives are needed.

Successful replacement of Obamacare health plan:

The success of replacing Obamacare with a better, cost-effective option depends on implementing a well-thought-out, simple but resilient plan that can be launched seamlessly, while minimizing dropouts of current coverage.  Moreover, it is critical that there is no gap between repealing and replacement, thus, none of those currently insured under the Affordable Care Act (ACA) would fall through cracks of not having insurance.  Thus, a smooth transition is essential from the ACA to the new plan.  Considering all ACA registrations are in electronic format, this should be able to achieve relatively easily.

Considering the above, lot more work need to be done by the Unites States law-makers to come up with a unified replacement plan for the ACA.  Nevertheless, the Congress must repeal and replace of the Obamacare, at the same time.  What is most important is to get the legislation right; even if the Congress have to delay the proposal to generate and verify the needed additional logistical, legal and fiscal work up.  Rather than rushing into unknown territory, such calculated and thoughtful actions will be paid off in the long-run.

Logistics of Plan replacement:

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

Obamacare registration process was marred by government website malfunctions and the lack of assistance from the staff who were not-trained to assist clients.  Therefore, the administrators of the new plan must ensure that the online and telephone registration processes, customer support, and the entire operation are straightforward.  It is utmost important to avoid all mishaps, as happened with the Obamacare.

Those who are writing the law and its interpretations, should also need to make sure that the contents are simplified for the ordinary people to understand.  We hope the new law will have only few dozens of pagers, not over 900 pages as the ACA.  Plan also needs to incorporate the Medicaid and Medicare sectors, perhaps allowing a reasonable contribution from the recipient, making it sustainable at the state level.  It should have guaranteed “low-cost” healthcare options.

Lowering the cost and affordability:

However, the goal of keeping the cost low (for the consumers and the government point of view) cannot achieve unless, the area of cost-containments is addressed.  Many of these areas were included in the previously published, Obamacare, Sections I through III).  Further points to be included are, increase completion by insurers, mandates for insurance companies to prevent pulling out of markets, federally-mandated malpractice cap of $250,000, thus lowering the costs of malpractice insurance cover.

The principle is the “affordability for all”, including for the government, and thus it will create the long-term sustainability.  In that regards another mandate needs to be included in the legislation is capping the annual increase of insurance premiums, per the annualized inflation rate.  This is essential to prevent the extra-ordinary increase of insurance premiums that we witnessed during the fall, 2016.

Healthcare cover for all:

While giving the opportunity for all Americans to have insurance cover is important, providing it free of charge is not.  This is in parallel to providing free tuition to all university students in the U.S., as pushed by Mr. Berny Sanders.  Such would not only add to the deficit another one-trillion dollar annually but also erode the value of university education.  Using a similar principle, the provision of healthcare to the populous in the United States should not be completely free (no free lunch).  Instead, it should include a staggered premium system, based on the income.

Except for a federally-defined low income group, such as half of the federally-declared poverty line, all others (who can afford some amount of payment) should be provide the opportunity to purchase the new plan of what they need at a cost that they can afford to.  Such approach will dramatically increase the value, while markedly decrease the governmental expenditure (i.e., reduced subsidy need) and make the plan, self-sustainable.

Electronic security in healthcare:

Healthcare is particularly vulnerable for data breach.  Most storage healthcare data and electronic medical records contain millions of confidential information, including social security numbers and other personal information.  It has been reported that the healthcare security breaches affected number of individuals to has been tripled during the last two years.   It has also estimated that per record (person) cost for healthcare data breaches as the highest in any industry.

Many positive steps have been taken and new legislations to prevent healthcare data breach (most of them are punitive) have been introduces over the last decade to control this.  What is lacking is strengthening the cyber security at various levels.  Over the past few years, attacks on organizations including various government sites have increased, it is paramount to protect our large healthcare databases proactively.

However, with the new trend of widely sharing digitized personal records by third-party vendors, pharmacies, insurers, among physicians and other payers and providers, including the government, could open the doors for new threats and vulnerabilities.  These stored electronic data at multiple sites and, particularly the process of sharing it though the Internet/cloud must be thoroughly secured.  While increasing data of sharing will improve the quality and efficiency of patients care, and safety (e.g., minimizing prescription errors and prevent abuse of addictive drugs such as opioids, etc.), it may also place patients at a higher risk of personal data theft.

 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


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