Rather than replace the Affordable Care Act, legislators should take steps to fix it, a pair of Stanford-affiliated scholars urge in a recent Foreign Affairs essay.
The most glaring problem plaguing health care in America is its unreasonably high cost, write Sejal Hathi, a Stanford MD/MBA student and Bob Kocher, MD, a partner at Venrock who helped author the Affordable Care Act. Yet there are examples of hospitals, communities and health care systems (such as Grand Junction, Colorado or La Crosse, Wisconsin) that have discovered ways to deliver higher quality care at a lower cost, they say.
The federal government can take steps to incentivize these top performing programs and to provide consumers with information they need to choose the best value offerings, Hathi and Kocher write. Admittedly, that isn't easy:
As they seek to encourage the use of the highest-value care, policymakers must make sure they don’t further perplex patients already struggling to make sense of their plans. No consumer product rivals health insurance when it comes to complexity, and most Americans remain in plans that they do not understand and do not wish to spend time trying to understand.
Again, legislation could encourage, or even mandate, that insurance information is transparent and comprehensible. Then, patients should be financially encouraged to make wise, ultimately cost-saving decisions, Hathi and Kocher write. They explain:
Traditionally, efforts have focused on getting patients to assume a greater share of the cost of their health care, but that has proved to be a blunt instrument, indiscriminately reducing the use of both necessary care and discretionary care. In recent years, insurance companies have rolled out new plans designed to encourage patients to make smarter decisions: patients pay more out of pocket for services that evidence has shown to be less beneficial (say, surgery for back pain that could be treated with physical therapy) and less for services deemed more beneficial (such as colonoscopies for patients at risk of colon cancer).
Their piece offers a host of other recommendations for both federal and state policymakers, unified by a basic assertion: Everyone should have health insurance.
But realistically, is this possible? Isn't health care just another issue likely to be shredded -- or stymied -- by caustic political battles? Not necessarily, Hathi and Kocher write:
...most of these recommendations are incremental in nature and capable of gaining bipartisan support. Both parties should find something to love in them: cutting costs and reducing the debt could motivate even stalwart Republicans, and expanding coverage to include the most vulnerable should inspire Democrats. Indeed, the benefits of reform are enticing. Billions of dollars of wasteful spending would be liberated for use in other parts of the economy. One of the biggest sources of the national debt would shrink. Millions of Americans would gain coverage. If that’s not enough to generate political will, then what is?