The Healthcare Revolution Will Not Be Televised…From Washington D.C.

This is something that I’ve been thinking about for a few weeks now. With the current status of “healthcare reform” in Congress, I thought I should take some time away from putting the final touches on my healthcare leadership book to provide my thoughts on these issues. Speaking of leadership, lesson #1 (which many of us learned in grammar school) is not to claim you can do something when you have no earthly idea how to do, i.e. repeal and replace with something better, with lower premiums and not touch Medicare.

Obviously, we can’t rely on Congress to provide what should be the inalienable right of healthcare coverage for as many people as possible at a reasonable cost. Fixing healthcare shouldn’t be about how much or how many we can cut from healthcare, but how can we cover more people. Lack of healthcare coverage for everyone costs all of us more than we know or care to think about. Healthcare coverage should not be a political issue. It’s a public policy issue. The questions should not be about, “If we should provide coverage?”, but should be about, “How can we provide the most coverage?”

We, as constituents, should be thinking about how can we trust a Congress who does not have to experience the same problems with healthcare that we do? They have access to the best healthcare coverage for the rest of their lives with little, if any, cost to them. They don’t understand the burdens the rest of us have to live with every day to make sure our families receive the best care at a cost we can afford or how it feels not to have or not be able to afford coverage for you and your family? I’ve felt that when I was between jobs one time and I prayed every day that my very active son would not do something that require us to take him to the doctor for another sprain, dislocation or twist that required X-rays.

No matter what they do in Washington, they are only addressing part of the problem – access to healthcare coverage. The real problem is the unsustainable cost of healthcare that really needs to be addressed. These costs include healthcare insurance premiums, pharmaceutical costs and acute care costs. Although hospitals bear most of the brunt of “free care” provided to those without healthcare coverage, data shows that there are wide disparities in the costs of care at the state-level and even within states. Without addressing the cost of delivering healthcare, all they are really doing is putting lipstick on a pig. It’s still a pig! (no offense to any pigs who might be reading this)

As a healthcare researcher and author, I am asked to speak at and attend conferences all over the world to discuss implementing healthcare analytics or improving leadership. I remember the words of another speaker at a Precision Medicine Congress in London that I was also presenting at remark how even on his bad days at England’s National Health Service he reminds himself that “at least I’m not working in the U.S. healthcare system.”

Congress has gotten away with these tactics by perpetuating a series of untruths and misinformation that people who aren’t in healthcare or don’t have access to the same thought leaders I do might easily fall for. Some of the most blatant ones include:

We shouldn’t have to pay for the healthcare of others who don’t have coverage. The truth to the matter is that we already do. This was before the ACA and will be after whatever comes next. The fact is that when someone goes to the hospital emergency room, most hospitals are required to treat them, even if it results in an overnight stay. That is called ‘free care’ and is something negotiated with the health insurance providers with the costs rolled into the price of our individual health insurance premiums. Therefore, when someone goes to the emergency room for something that could have been prevented with regular healthcare, not only are they accessing the most expensive form of healthcare, but we are the ones ultimately paying for it.

As an example of how misinformed people can be, I was working on a project at a hospital and taking the elevator down to the cafeteria to get something to eat. One of the janitors got on the elevator and we started talking. She asked me what I did and I told her I was a healthcare consultant. She started going on about how it was so terrible that the government was going to make her buy health insurance. I explained to her that we all pay for the healthcare of those that don’t have health insurance through our premiums. I asked her if she had health insurance and she told me that she didn’t. I informed her that I was basically paying for her healthcare when she went to the emergency room. Silence.

The ACA’s individual mandate is bad for people. I admit that the individual mandate didn’t work the way it was expected, and the reasons are for another discussion and it’s not because of the spin we’ve been told out of Washington. The individual mandate was meant to balance out the risk in the insurance pool. The healthier people were to cover some of the costs for the older or sicker people. When the younger, healthier people chose to pay the penalty instead of buying insurance, the insurance pools were filled mostly with older people with more health issues. It was supposed to work like any other insurance pool, like automobile insurance or even social security. In the state of Illinois, everyone is required to have auto insurance. You are fined if you are caught driving without auto insurance. By forcing everyone to have auto insurance, the companies can keep the rates down because in the case of an accident, most likely all parties will have insurance coverage. In some states, auto insurance rates are increasing because of the higher risk of people texting and driving. You may not be texting while driving, but your rates are going up also. Also, think about what would happen to social security if contributing was voluntary versus a requirement. It would be a disaster.

The ACA is failing. Granted there are some states where insurers have pulled out or the individual choices are minimal, but from I’ve been told some of that was expected and some insurers were just not suited for the marketplace. Another reason for the turmoil in the marketplaces is the uncertainty over how healthcare would be administered in the future. Congress’ failure to provide a clear direction by accomplishing something has added to this turmoil.

A benefit of the ACA is the reduction in bankruptcies. According to Consumer Reports, bankruptcy filings have dropped by 50% from 1.5 million filings in 2010 to 771K in 2016 (the ACA went into effect in 2010). Although they cannot definitely attribute this drop to medical bills, many bankruptcy and legal experts agree that “medical bills had been a leading cause of personal bankruptcy before public healthcare coverage expanded under the ACA.”

People who need can’t afford their own coverage are poor and lazy. This is the one that bothers me the most. Saying that every poor person is lazy is as bad as saying every rich person is greedy. Both statements can’t be further from the truth. A study by the Economic Policy Institute indicated that only 24% of the people in poverty who are eligible to work (not retired, disabled or students) are not working some type of full-time or part-time job. If you listened to many of the pundits, you would have thought the number would be in the 75 to 90% range, but obviously that is incorrect. Therefore, most of the people who can’t afford healthcare coverage are not lazy, but working people trying to put food on the table and a roof over their family’s head. They just don’t make enough to also pay for health insurance.

The solutions to our healthcare problems have to come from outside of Washington. We need a coalition of healthcare leaders to develop some solutions that benefit the public. I get to meet some very smart people at the conferences I participate in and there are some very good ideas out there that need further exploring. I know I don’t have all the answers, but as a college professor I’m good at facilitating discussions and that is what we need. With the right people, I’m sure they would be able to come up with something better than what we have and better than anything being proposed. For this to work we need representation from every part of the healthcare ecosystem including hospitals, pharmaceuticals, insurance companies, physician and hospital associations as well as academia and technology. No politicians. Everyone would need to leave their politics at the door and come prepared to find solutions for our greater good. If we don’t do this for ourselves, who will?

If you think this would work, please let me know by liking or commenting on this post or retweeting it from @jbryanbennett or @healthcarecoe use #healthcarerevolution. With enough support, we can make this happen. Let’s declare our independence from the broken healthcare policy as usual.

{Professor Bryan Bennett is the Executive Director of the Healthcare Center of Excellence in suburban Chicago, Illinois. He is the author of the book “Competing on Healthcare Analytics” and the upcoming book “Prescribing Leadership in Healthcare”. He is also an adjunct professor at Northwestern University andJudson University where he researches and teaches courses in analytics, leadership and marketing.}