How a bad healthcare bill can lead to better healthcare
The healthcare bill currently being debated in the Senate is the culmination of a century-long story. If you rely on Medicaid, Medicare, or other government subsidies to afford care that you need, your access is seriously under threat. But all is not lost. There are still things you can do to take back control. But to know where you need to start, you need to understand the history of how we got to where we are today.
Healthcare is transforming at an rapid pace in the United States. We started the 20th century with doctors as an on-demand, cash-based service. But by the 1960’s, the creation of Medicaid and Medicare lead to a system run by insurance companies. Hospitals have become like industrial factories. Systems and processes were developed to help insurers accurately predict costs while increasing volume of patients served at the same time. And pharmaceuticals became a key part of a strategy of measurement and control by doctors.
Obamacare — the healthcare bill to rule them all
By the 1990’s, insurers and pharmaceuticals together controlled a majority of revenues generated from care delivery. Yet hospitals across the nation struggled to keep the lights on. Public health officials were just beginning to recognize obesity as an epidemic. There were some attempts at a healthcare bill that would reform the system. But the prosperity of the 90’s held back the political will to rock the boat. Only the recession in 2007 could provide a Congressional mandate strong enough to enact a change as sweeping as the Affordable Care Act. The ACA required all citizens to carry health insurance and established marketplaces to provide subsidized access to private insurance.
Diminishing value proposition
The truly abysmal state of health of the average citizen was a surprise to insurers, and in an effort to protect their bottom line they have continually raised premiums for plans on government exchanges. 2017 has seen a premium increase of 22% (compared to a 7.2% increase in 2016 over 2015 rates). While a majority of Obamacare enrollees will be shielded due to subsidies, the sticker shock did dominate discussions about the program. For those who do not qualify for subsidies on the exchange, or who are enrolled in plans through their employers, premiums have risen faster than wages. And customers are paying more for the same or for worse coverage.
As more and more major health plans pull out of exchanges, the value proposition of Obamacare to all but the poorest and unhealthiest citizens will continue to decline.
The wheels are finally coming loose
The economics of healthcare in the US are divorced from its outcomes. Very, very divorced from outcome.
There are tremendous inefficiencies in how primary care is delivered and how care providers are compensated, which results in hospitals and doctors being incentivized to focus on specialties (orthopedics, surgery, cardiology, etc) rather than primary or preventive care. As a result, the US has the best survival rate in the world for cancer and other major diseases. But it comes at the expense of unacceptably high rates of lifestyle-related issues like heart disease, Type 2 Diabetes, obesity, and hypertension.
Rates of chronic conditions linked to lifestyle have strong positive correlation with poverty. The strong intersection of ethnicity and poverty in the US means that poor communities of color have some of the highest prevalence of chronic health conditions. Much of this has to do with two main factors:
- lack of regular engagement with professional medical practitioners
- living in an unhealthy environment with limited access to healthy options
The lessons we can learn from Obamacare’s failures
Obamacare assumed that a lack of health insurance was the primary reason why so many did not have regular primary care, and that more engagement would magically address the social/environmental barriers to a healthy day-to-day life. The percentage of uninsured has dropped dramatically, but while we have seen improved access to primary care there has been no impact on the growth of the obesity rate across any demographic group.
Even with health insurance there is a wide range of social, environmental, cultural, and financial barriers that low income or patients of color face in receiving the support necessary to make dramatic shifts in health behavior. For the most part, neither insurers nor care providers are equipped with care protocols to address those barriers. So health disparities will continue to rise in lock-step with income inequality, in spite of more people having access to basic check-ups.
A bad healthcare bill that gives us the chance to fix things ourselves
It’s doubtful that Obamacare could have lasted in its current form even under a supportive Clinton administration. The GOP will — for at least 2 years — have full control of government. As I predicted shortly after the election, passing a GOP-branded healthcare bill has been a top priority for 2017. We will see a return of national health policies that focus exclusively on reducing actuarial risk and ignore opportunities to create real value for consumers. Instead, we need to create community-specific solutions that are run independently from government programs.
The inevitable removal of the Obama “safety net” is an opportunity for people to put their money where their mouth is and mobilize at the local, community level. Good health is the foundation for strong communities, and strong communities persevere no matter who controls the government.
A glimpse of an alternative model
The alternative model starts at home at the individual level with four major areas in life that require attention. To understand the type and level of health services we each truly need, we should take stock of our health status in each area.
- Emotional Health — How you relate to yourself and to those around you?
- Physical Health — How close your body is to its full capability? How well are you eating, sleeping, and making sure your body is moving?
- Financial Health — How much of a plan do you have in place to reach the goals you have in life?
- Social Health — What value do you create for others within your community? What communities of mutual support are you part of?
We created Primal Red to help people identify and address their needs across each of these areas. Our goal is to create a space where every interaction you have is one that leads to improved health — financial, physical, emotional, and spiritual. These are the types of interactions that help build resilient, connected communities.
Modern healthcare steers people towards services that generate the most profit for insurance and pharmaceutical companies. For healthcare to actually lead to better health, it should steer people towards services that help them become their best selves in all areas of life. A better healthcare system is one that profits when everyone is healthy.
Join us and let’s make that happen together!
Primal Red is a platform for connecting with local services that help you take greater control over all aspects of your life. Emotional, Physical, Social and Financial.
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