In case you missed the confirmation hearing for secretary of Health and Human Services, Tom Price repeatedly defended his policies under “six principles” that he believes should guide our health care reform: affordability, accessibility, quality, innovation, choices, and responsiveness. Reality check—Tom Price’s purported “guiding principles” are ironically more in line with Obamacare aka the ACA (Affordable Care Act) than his proposed replacement, the “Empowering Patient’s First” act. Let’s take a closer look.
Many people falsely blame the ACA for increasing premiums and deductibles. In fact, since the law was passed, costs have risen at a lower rate than they had before the ACA. The growing health care expenditure—a result of the profoundly flawed and problematic structures of health care delivery that have evolved in the U.S.—is a real challenge we have been facing long before the ACA, and is deeply entrenched in the interests of powerful stakeholders (*cough* Dr. Price’s stock exchanges *cough*).
The result is a nation that spends the highest amount per capita on healthcare, with the poorest health outcomes compared to other developed nations. Although the ACA looks to sustainable solutions to these systemic failures, once passed, the law instead became the scapegoat for every negative feature of an already-broken system. Yes, there is much more important work to be done to fix healthcare, but the ACA was never meant to be a finished product. Doesn’t it make sense to build on the elements that work instead of dismantling the entire system and all the progress that has been made?
On the other hand, the “empowering patients first” act pays an enormous price (pun unintended) to achieve “affordability.” Permitting insurance companies to sell low-cost, high deductible (aka catastrophic) policies, “empowers” young and healthy patients with more affordable options. The trade-off is a market that exponentially drives up the price of regular healthcare plans, harming those who rely on comprehensive coverage, particularly women seeking reproductive care, the elderly, and the sick. It‘s also a slick legal loophole around the non-discrimination provision of the ACA, designed to protect patients from being charged higher premiums based on gender or health status. Not so empowering after all.
”Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” — Dr. Martin Luther King
Let me be clear. For the first time in American history, the ACA has provided the means for universal healthcare. Since the law was passed, the rate of uninsured has dropped from 18.5 percent to an all-time low of 8.6 percent.
For almost seven years of opposition to the ACA, Republicans, including Tom Price, have failed to produce a single replacement proposal that would guarantee continued health coverage for the 23 million newly insured Americans. This is because there is no better way (sorry, Paul Ryan) to simultaneously expand universal coverage, improve quality, protect patients’ rights, and control costs within American’s current health care system.
And speaking of recalcitrant conservatives, ever wonder why the uninsured has not approached zero? Well, once the ACA passed, many Republican legislators refused to expand Medicaid in their states despite compelling federal incentives. That’s right, entire groups of citizens in 19 non-expansion states were denied the right to health care, strictly based on the partisan determination to obstruct the success of Obama’s legacy.
Policies in the ACA seek to reform healthcare by embracing the “triple aim”—improving patient experience and satisfaction, improving the health of populations, and reducing per capita cost of care. This means creating incentives that reinforce high-quality care, as opposed to quantity. Along these lines, the ACA reorients health care towards a primary-care-based-system by guaranteeing free preventive services such as wellness visits, birth control, vaccines, and cancer screenings including pap smears, mammograms, and colonoscopies.
The idea is simple. Charging co-pays for services can deter patients from seeking care. Instead, ensuring primary care services are free helps catch disease earlier and promotes behaviors that keep our nation healthy.
To achieve the “triple aim,” the ACA has also supported the development of innovative, high-quality models of health care delivery. As a result, hospitals and clinics around the nation are experimenting with new and exciting care delivery systems intended to define future practices and policies. Some promising innovations include health navigators to help manage medically complicated patients, integrating behavioral health and substance abuse counseling into primary care practices, and partnerships with local fitness centers to promote healthier lifestyles.
Contrary to the promises made by the GOP, it is essentially impossible to craft an alternative plan that preserves an all-inclusive provision for preexisting conditions without an individual mandate. To many, this may seem unfair. But without the mandate, healthy individuals could defer buying a health insurance policy until they got sick, knowing they could never be denied coverage. Meanwhile, the health insurance industry would collapse under the economic burden of an exclusively high-risk patient pool.
We are quick to forget that before the ACA, refusing coverage for preexisting conditions was a common business strategy used by insurance companies to evade paying for costly treatments, forcing vulnerable patients to “choose” between catastrophic debt and death. Half of Americans currently have a medical diagnosis such as diabetes, cancer, or a mental illness, that could qualify as a preexisting condition—the remainder are merely one accident or tragedy away.
So how will the GOP get away with repealing the mandate? By limiting the protections for preexisting conditions under the guise of “preserving them.” In Tom Price’s plan, patients with preexisting conditions will not be denied coverage so long as they maintain “continuous coverage.” In other words, a patient with a compromising medical condition could never have a gap in coverage, even under extenuating circumstances such as a debilitating illness, loss of employment, or inability to afford a monthly bill. Is the “option” to buy insurance worth empowering a profit-motivated industry with the “option” to withhold health care?
Under incentives created by the ACA, providers seek patient-focused feedback to inform improvement. This is also known as “quality improvement.” Using transparent quality indicators such as blood pressure control and patient satisfaction scores, clinics and hospitals are held accountable to patients needs and have incentives to make system-based changes to improve measurable outcomes. As follows, a patient-centered model of health care has become the provider gold standard.
Obamacare wins in all six categories
Tom Price wants to “empower patients” with more options that disproportionately benefit the wealthy. He wants to improve innovation by decreasing regulations (i.e. patient protections) and enabling a profit-oriented system. He wants to dismantle Medicare and Medicaid.
One must ask themselves, “Who does Tom Price really empower first?” An analysis of his sketchy business conflicts and policies would suggest the wealthy, physicians, the pharmaceutical and insurance industry, and other powerful stakeholders with financial interests.
As politicians push to rapidly act on the ACA, lobbyists representing every sector of the health care industry are defending their interests at stake. It is therefore so essential that we, the consumers of health care, are informed, engaged, and prepared to defend our health priorities at stake.