Healthcare is not a federal responsibility — leave it to the states

This commentary was originally featured in The Hill  on May 29, 2017

Media focus on healthcare continues to be stuck down in the weeds. They never look at the big picture and the public is blind to what matters.

Washington’s 2008-2010 focus on healthcare culminated in the Affordable Care Act, which reformed health insurance. A recent Assistant Secretary for Planning and Evaluation report showed that ObamaCare’s “reform” doubled the cost of premiums. Where was the focus on improving access to care — the reason for a healthcare system in the first place?

Congressional efforts at healthcare reform such as the ACA and now American Health Care Act (AHCA) could be likened to fixing a computer. In this metaphor, the computer is our healthcare system. You experience a problem, such as overspending. Congress applies a patch called the Sustained Growth Ratio (SGR), which cuts payments to Medicare physicians. However, that patch creates a new problem: no doctors.

Washington added another patch called DocFix, which suspended the SGR. The DocFix patch created a problem: impending Medicare bankruptcy. The fix for the DocFix that fixed the SGR is a new patch: a $716 billion reduction by the ACA from Medicare spending.

A new administration comes to Washington promising to repeal and replace: “repeal,” i.e., remove, the pile of patches on healthcare placed by the former administration and “replace” it with a system that works.

The House of Representatives interpretation of repeal and replace was a mesh of patches called AHCA. The first was placed on the fiscal hemorrhage called the national debt. The ACA doubled it. AHCA might reduce deficits by a small amount over ten years. This is not a fix and does nothing to improve patient care.

Then there are AHCA patches to try to stabilize the insurance market: a tax credit patch, an insurance bailout patch, and patch for high-risk patients. These all cost money. None improves our access to care, Ironically, the insurance market patches negate the deficit reduction patch. AHCA takes away insurance coverage from millions of newly insured Americans from coverage. Whether this affects the availability of care is a different issue and could require yet another patch.

AHCA patches are placed on top of ACA patches. The latter weren’t removed by AHCA — the entire ObamaCare maze of regulatory and administrative patches remains intact. 

The storyline now shifts to the U.S. Senate. They have concerns about the exact placement of the House patches. Senate members are meeting behind closed doors, so we only hear what is leaked to the press. We know how trustworthy “unnamed sources” are. While no one is sure what Senator Susa Collins means by “starting from scratch” on AHCA, they are sure to add Senate patches on top of House patches, which are overlying Obama’s patches, that were placed over Carter, Reagan, Clinton, and Bush patches. 

Ask anyone who knows computers what happens when you put patcheson top of patches on top of patches? The computer stops.

That is what is happening to U.S. healthcare. When healthcare is consuming almost twenty percent of GDP, Medicare is approaching insolvency, and people can’t get in to see a doctor, the system is approaching total meltdown. Collapse is not hyperbole but sad fact.

If patching isn’t the answer, what is? As a physician, I can tell you but I must warn, it will hurt. Ripping patches off is painful. Worse, the major changes that are necessary to save healthcare will produce great anxiety. Change always does.

Instead of adding new patches, Congress must take off all existing patches, and look at why our healthcare system is failing.

The root cause is a malignant federal healthcare bureaucracy, one that consumes more than 40 percent of all healthcare spending. Expecting this cancer to cure itself is waiting for something that will never happen.

The answer for healthcare is obvious, simple, painful, and frightening. Since cancer of the federal bureaucracy is the diagnosis, the cure is to cut it out. Remove Washington from healthcare. Healthcare is not a federal responsibility.

Let the states decide. Listen to State Sen. Ricardo Lara (D-Calif.) advocating a single payer system for California. “Given this picture of increasing costs, healthcare inefficiencies, and the uncertainty created by Congress, it is critical that California chart our own path.” 

Take off all patches. Do not add any new ones. Accept the root cause. Cure it. Instead of mandating ObamaCare, RyanCare, TrumpCare, or some other Washington-centric approach, let’s have StatesCare. Release the states to choose whatever healthcare structure each wants.