The problem with healthcare reform

We have been reminded, repeatedly, over the last few years that the healthcare system in the United States is a broken mess. We have heard political candidates explain to us, in rather simplistic terms, how premiums are rising, healthcare is increasingly un-affordable, and the system is going broke. We saw the whole nation collectively decry Martin Shkreli and Heather Bresch for price gouging, and then lambaste former-President Obama for insurers dropping coverage options in health insurance exchanges. And over the course of what feels like a four year run-up to the elections, Americans have heard a million different proposals, from both sides of the aisle, on how to ‘solve’ the healthcare puzzle. This has led to a very vocal, vitriolic, and surprisingly-detail-void, public debate over healthcare reform.

But this debate might be a little off-base when it comes to solving the real issues. Because all too often, people are more focused on their day-to-day problems: the high premiums, out-of-pocket costs, and getting coverage; rather than the issues underlying these problems. For example, the high cost of premiums cannot be fixed by Obamacare subsidies or by tax credits. Competition in the insurance marketplace does not actually address the cost of healthcare services. And the individual mandate might increase insurance coverage, but it doesn’t address healthcare quality. The public debate in healthcare reform is almost always about trying to solve the symptoms, instead of examining the underlying problems that cause those symptoms. Fixing these symptoms alone will never lead to holistic healthcare reform.

Fortunately, there is still hope. Under the often ignored Medicare Access and CHIP Reauthorization Act of 2015, CMS launched a comprehensive Quality Measure Development program to reform physician payments and healthcare quality. Thanks to Martin Shkreli, legislators don’t squirm anymore at the first mention of drug price controls. And the latest republican reform proposal even suggests medical malpractice reform. But there is work to be done to open up the debate on tougher issues such as managing price without hurting innovation, patent reform, end-of-life care, reforming regulation of Pharmacy Benefit Managers, price transparency, and many other issues. The real fight for healthcare reform is happening behind the curtains. But the public spat on this issue is the ground underneath the battle. So it’s time to start debating the real issues!

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