As physicians, we are wondering whether the road to health care reform in America goes in circles. Employer-based coverage began in the 1940s, followed by the creation of Medicare and Medicaid in the 1960s and the rise of health maintenance organizations in the 1970s. In between these major developments was the expansion of Medicare 10 years ago and periodic proposals for universal coverage. All of these health-care delivery systems have been revised, reviewed and second-guessed.
Here we go again. Congress is debating how to repeal, replace or possibly repair the Affordable Care Act, the 2010 law that became the focal point of much political acrimony. Now that he is confirmed by the U.S. Senate, this is the time to ask whether the person charged with leading us down this road, medical doctor and Congressman Tom Price, is receiving constructive feedback over the health reforms he has championed during his time in Washington.
Dr. Price will be the first physician to run Health and Human Services in nearly three decades. Moreover, his legislative reforms are in the public record as are his goals for running the agency now that he has appeared before two Senate confirmation hearings. Politics aside, Congress has a tremendous opportunity here to legislate health care reforms in a bipartisan manner and for Dr. Price to implement them.
Since the onset of the insurance-based health care system we have today, there is one common theme: Well-intended policies have merit, but all have added administrative burdens on doctors and consumers alike. We are left with a frustrating and bloated bureaucracy. The Affordable Care Act succeeded in addressing some of the worst aspects of modern health care, most notably creating a mechanism whereby people with pre-existing medical conditions could obtain insurance coverage and lower-income individuals could likewise obtain coverage largely through the expansion of Medicaid.
Where the Affordable Care Act came up short is in adding yet another layer of bureaucracy and frustration, and worse, disrupting the insurance industry and affecting people’s access to medical care. Who can forget the rollout of the online marketplace in Maryland when consumers’ computers crashed and the system struggled because policy preceded technology and capacity. Everywhere, there seem to be fewer patient choices as medical networks contract and insurers leave the individual market.
There are also double-digit percentage premium increases and more government mandates affecting businesses and consumers. These same problems affect physicians as we are forced to abandon patient relationships we have had for years and accept more hassles to comply with costly systems that do not always advance quality patient care. Feelings like this, in part, led to this new environment where much of the law will be repealed.
But repealing the Affordable Care Act is easy; far more political difficulty lies in replacing it with solutions that ensure affordable and quality health care. Before dozens of senators, Dr. Price laid out core principles on which he would work with Congress. Centered on patient choice, affordability, accessibility, quality, responsiveness and innovation, he has laid out a road map for Congress to follow.
As a member of Congress himself, Dr. Price advocated putting patients back in charge of their health care. His legislative proposals included creating health insurance pools for individuals with pre-existing conditions, tax incentives to obtain insurance coverage and the ability to purchase policies across state lines. Maryland has recent experience with one component of these reforms.
The Maryland Health Insurance Plan, the formal name of the state’s high risk pool, had the third highest enrollment rates in the country according to the Kaiser Family Foundation. Created in 2002, the plan, since terminated, enabled access to affordable, comprehensive health benefits for medically uninsurable individuals. The plan was not perfect, and premiums were not cheap. Dr. Price’s legislative proposals, however, included funding to make such plans more affordable.
For years, front line physicians have been left out of the reform process in favor of academics, economists and bureaucrats. Perhaps well intentioned, some of these actors nevertheless relied on raw political calculation to create the system we know now. As practicing physicians, we hope that Dr. Price can lead a charge to restore the doctor-patient relationship.
We also hope Dr. Price’s unprecedented combination of legislative and medical experience will enable him to safeguard and improve the American health care system. We look forward to working with him to advance our quest for a safe, stable and predictable health care system that provides everyone access to high quality and affordable health care. We are long overdue on driving full speed ahead toward these objectives.
-Dr. Amar Setty is the past president of the Maryland Society of Anesthesiologists