Health Reform – Is This a 1960s Moment?

Posted on | February 12, 2018 | 1 Comment

Mike Magee

Quietly rising out of the ashes of the Republican led campaign to “repeal and replace” the Affordable Care Act, are pragmatic efforts, not focused on “if”, but focused on “how” and “when” the U.S. will join all other developed nations and provide all of her citizens with affordable, high-quality care.

Last week, a new bipartisan coalition led by Obama-era health policy guru, Andy Slavitt, and former Republican senator, Bill Frist, called the “United States of Care”, was announced. A consensus building effort featuring early listening tours, policy papers from the University of Pennsylvania, and a commitment to long-lasting solutions, did lay out four “musts” including: 1) universal (”every American without exception”), 2) high quality, 3) efficient (which included affordable for all, and sustainable for the country financially), and 4) equitable (no exclusions of coverage).

Grounded in optimism and consensus building, the “United States of Care” believes they can “redefine the goal in human, not political terms.” They make sure to tip their hat to American exceptionalists at the center of the Medical-Industrial Complex by stating that, “America leads the world in so much of health care. We drive world class research and…scientific innovation…that the rest of the world benefits from.” And “we have a highly trained clinical workforce that is the envy of the world.”

Of course, whether those innovations and skills deliver full human potential for all Americans or simply profitability for the entitled remain richly debated. But to their credit, they say straight up that we have real problems – vulnerability, limits on access, and unaffordability – which translate into “living in fear.” Bill Frist writes, “Our patient is the United States health care system, and it is very sick.”

If there is good news, most agree it comes in two forms: 1) There is ample money on the table if only it can be efficiently redirected. 2) Individual states, unleashed by Obamacare inducements, are in an experimenting mood. It is at these states that Slavitt and Frist and cohorts are targeting their listening tour with a subheading “Galvanizing Public Opinion and Taking the Conversation to the States.”

Institutional partner, U Penn, has added granularity in a white paper of its own. Opening with the fact that 28 million of our citizens continue to lack insurance coverage, they emphasize that coverage = access to 5 critical realms; primary care, preventive care, chronic illness treatment, medications, and surgery. (Left unaddressed is whether too much of any of these things might make you sicker rather than healthier.)

The paper then analyzes five states that have had a go at universal coverage including MA, VT, CO, NV, CA. In general, they all were focused on closing the “coverage gap”. But they had multiple other objectives as well including: cost-control, stabilzation of state insurance markets, and more choice of plans.

The analysis demonstrates that there are multiple pathways that lead to universality, just as there are many ways to undermine solidarity including: 1) Lack of clarity on financing, 2) Lack of clarity on long term sustainability, 3) Private sector fears of price controls and job loss, 4) Unclear federal government support for state-based solutions, and 5) Proposals that suggest drastic tax increases.

There is a certain amount of déjà vu to the “Can’t we all just get along?” model of health reform. After all, the AMA and allies used “Red Scare” tactics, fighting tooth and nail in the late ‘50’s and early ‘60’s to block progress in health coverage. Their main strategy (coordinated with other members of the Medical-Industrial Complex) was to feign cooperation and offer voluntary policy pablum, while at the same time hiring GE’s Ronald Reagan to mobilize letter-writing doctors wives and rent the Madison Square Garden for a rebuttal speech to JFK’s appeal for expansion of health care.

At the end of the day, it was LBJ pulling Wilbur Mills strings, that carried the day and rammed Medicare and Medicaid through. Once there, American seniors couldn’t quite figure out how they ever managed to live without it.

Now those very same Americans, and their children and grandchildren, hold the strings to our futures – with the 2018 election just 10 months away.