An

Open Letter to Congress: Real

Healthcare Reform Requires Guts,
Strategic Vision and Time - Get to
Work!

Here’s a politically-agnostic view: We, the American people, are fed up, totally
disappointed, frustrated and otherwise weary of political whimsy when it comes to
developing a lasting and meaningful national healthcare strategy. In part, the
promise of disrupting the political elite’s dysfunctional, politically-motivated
process of enacting ineffective legislation and/or kicking the can down the road was
why Donald Trump got elected. If it were possible, we the People should be able to
sue our government for negligence, malpractice and maybe even malfeasance over
it’s inept handling of this issue over many years, let alone Social Security and
Medicare. Rome is burning, legislators, and you’re playing out-of tune fiddles.

This criticism goes for both parties and for both the ACA and the dead-on-arrival
Republican equivalent. The ACA has so many flaws, including unacceptable, over-
reaching mandates, government-expanding subsidies/administration, taxes, and a
lack of comprehensive strategy to name just a few. And the process of its passage
was insulting to the American people – “You need to pass the bill to find out what’s
in it.” Really, are you kidding us? Yet it’s inconceivable that after literally years to
come up with a winning solution to Obamacare the Republican’s attempts were so
shallow and feeble at addressing key issues that need to be solved. Bottom line: it’s
unacceptable and downright embarrassing that our country, long a world-leader in
innovation and industry, hasn’t developed a sound solution to this mega-problem
yet. Smaller countries with far fewer resources have already done so and most
spend far less per-capita on their healthcare than we do and have healthier
populations.

So here are a few things to aspire to, legislators, as you move forward with your next
attempt:

Be Bold: Lay down your incessant wrangling and forget about getting re-elected.
We need a lasting strategic solution. Take risks. Show us you’ve thought about this
problem and considered a range of solutions including out-of –the-box innovation.
Show some guts for a change!

Be Comprehensive: This is probably the thorniest, most Byzantine mega-issue we
have to solve as a country – “Who knew healthcare could be so complicated?” Yea,
really Mr. Prez. We can’t afford to have a piecemeal approach designed to placate
voter factions you politicians are trying to solidify or acquire for your next election.
Hey, wake up, it’s not about you, it’s about the American people! We need a
thoughtful, multi-stage solution that can get us from the current state, through a
transition period, to a better future state. You know, the kind of planning even a
small size business might undertake. Think you can manage that? Here are some
components to consider in the next healthcare bill iteration:

• Prevention: improving the health of the overall population through risk
awareness and preventive measures, especially in the Safety Net Plan (see
below). Evolve more swiftly from a sickness orientation to a health focus.

• Payment reform: a real timetable and commitment to move from fee-for-
service to outcomes based compensation for all clinical service providers
over time. Put real muscle behind annually update Medicare’s antiquated fee
schedule to reflect new technologies, surgical procedures and devices.
Medicare’s reimbursement schedule drives much of the compensation paid
for services.

• Competition: remove the barriers to interstate health insurance and allow
Medicare, Medicaid and the Safety Net Plan (see below) to negotiate with Big
Pharma to lower the cost of medications.

• Safety Net Plan for those who need it: why not have a national safety net
plan (not Medicaid) for lower income individuals that is administered by a
competent administrator like a major insurance carrier and go out to bid
every 3-5 years to ensure the government (a proxy for the People) is getting
a good deal and that innovation and price competition is rewarded?
Legislation could still dictate what is covered by this plan.

A national plan would ensure we build a design that is worthy of a great
country like ours and enables measurement and improvement over time. It
would be available to anyone who doesn’t have employer-provided coverage,
anyone below a certain income level and anyone who wants to opt out of
their employer-sponsored plan to get better coverage and/or lower costs.
Use the national safety net plan to replace Medicaid over time.


• Eliminate tax credits to buy the national Safety Net plan: Why do we need
the ACA’s convoluted system of tax credits - a euphemism for ‘we give money
to folks who can’t afford to buy healthcare coverage ’? Why not just have the
national safety net plan have different deductible levels. These levels could
depend on 1) the consumer’s prior year’s income level and 2) number of
years covered by the plan or an employer plan (to minimize gaming the
system by those who just want to buy coverage when they get sick)? Get the
 government out of the business of controlling and distributing the tax credits
that a skeptic might argue are just political means to pander to desired voting
blocs.


• Eliminate mandates in private plans: let companies decide for themselves
how generous or lean their plan design needs to be to attract and retain their
workforce. If the employer’s plan isn’t rich enough, let the consumer decide
if they’d rather buy the national safety net plan. The national Safety Net Plan
will compete with the private employer’s plan and, in so doing, may drive
design choices. Most importantly, don’t mandate that employers and their
employees accept conditions and coverages that are abhorrent to them. We
respect all citizens, right? Not just those who agree with the government’s
idea of required ‘essential benefits’.

• Increase supply of allied professionals: ACA was great at increasing the
demand for healthcare services by adding millions of insurance-covered
individuals to the system. Did it do anything to increase the supply of
qualified clinicians? Let’s make a moon-shot-like national commitment to
increase the number of primary care doctors, nurses and allied professionals
over many years to help mitigate the increase in cost one would logically
expect when you increase the demand for services but not the supply.

• Lower liability insurance costs: either cap the amounts that can be
awarded in all but the most egregious malpractice cases, develop a super
insurance pool, subsidize premiums for new clinicians for a period of years
(to lessen the cost of entry to the profession), or some combination of the
above.

• Reward Innovation: The ACA had a special tax levied on medical device
companies – some of the best innovators in the healthcare sector. Instead of
vilifying innovation we ought to be rewarding it. Consider incenting and
recognizing innovation that reduces cost, improves outcomes or makes a
major breakthrough through an annual, national competition governed by an
esteemed body of private-sector experts - the US equivalent of a Noble Prize
with real recognition and monetary incentive attached to it.

• Disclosure: Here’s an idea. How about before voting on any new healthcare
bill you require it to have an executive summary designed to be understood
by the average citizen? You respect your constituents, right? Give them the
information needed to make an informed decision about the biggest issue
before Congress in their lifetime.

Senators, Congressmen/women: we can do better – it doesn’t have to be a
political fight. Now get to work! The American People are counting on you.