In a New York Times oped piece yesterday entitled “Obamacare Hits a Bump”, Paul Krugman, the Nobel Prize winning Economist, succinctly explains why private insurance companies are raising prices and reducing coverage on policies that they offer on exchanges; or pulling out of the exchanges altogether. Not surprisingly, the reasons seem to boil down to profit and vindictiveness.
But then Krugman goes on to say “it would be quite easy to fix the system” by offering a ‘Public Option’ option on the exchanges. Although he may be correct that this would make economic sense (he is an economist after all), and maybe help the economic health of the exchanges, it will do little to fix our healthcare system.
Even though I was and am a supporter of Obamacare and believe it has done a lot of good so far, I believe that it is now time to move on. Not to repeal it, or spend huge amount of time and political capital on improving it, but to rethink how to approach healthcare reform.
The key to effectively and efficiently reforming our healthcare system is to first acknowledge that it is not really one system, but rather several autonomous healthcare systems competing with each other, with their own rules and with no oversight. There is Medicare, Medicaid, VA, HMOs, PPO, etc., etc., etc.. Each with its own set of patients and its own set of providers. This is not a healthcare system; it is a healthcare chaos!
And who has oversight of this chaos?
One part of the federal government (HHS) oversees Medicare and Medicare, while a separate part oversees the VA. Most of the rest has no direct federal oversight- only state regulatory controls.
With a vacuum like this, no wonder Congress and other federal agencies feel that it must make healthcare decisions. This is why we have had so many federal initiatives (many more than most of the public are aware) attempting to ‘reform’ the way healthcare professionals and healthcare facilities deliver medical care to patients.
This method of healthcare reform is no solution and will continue to have unintended consequences (like the insurance issues discussed by Krugman) as long as we continue with the delusion that we have one healthcare system.
The key to real reform is to first unify our entire system under one oversight body that is led by healthcare professionals and is independent of federal or state governments. There is precedence for this with the Federal Reserve, which was created over 100 years ago to regulate the US money supply at a time when our financial system was in chaos. The Fed took a chaotic banking and financial system (or systems) and created a unified system that eliminated redundancies and allowed for better economic health.
Why not have a similar oversight for our nation’s healthcare system?
This is one of the three innovations of a healthcare system reform proposal called EMBRACE: The creation of a Nationals Medical Board (NMB) to oversee the entire public and private healthcare system. Once the NMB is created, government agencies running healthcare related issues, like Health and Human Services, Medicare, Medicaid, Veterans Affairs, NIH, parts of the FDA, etc., will be eliminated and their jurisdiction transferred to the NMB. Private insurance will also be included (unlike in single payer models) in the NMB. It will truly be a “Single System” healthcare system.
The EMBRACE model also introduces innovations that would allow seamless integration of the latest scientific evidence into medical practice, without the bureaucratic hurdles that are now burdening doctors and hospitals.