Recently the Commonwealth Fund blog published a piece entitled: The Health Care Reform Proposals of Hillary Clinton and Donald Trump. The short version of the article is Clinton would keep the Affordable Care Act (ACA) with some tweaks and Trump would repeal the ACA and tweak what is left. I believe that to focus on the candidate’s respective proposals’ relative merits, as this article does (quite well), misses the forest for the trees.
The problem with almost all of the proposals that are being considered by the candidates, Congress and even the media, is that they represent attempts to fix small parts of the healthcare system- when its entire infrastructure is crumbling. It is an infrastructure that is over 100 years old with many autonomous mini-systems and no real oversight. These include the many government-run agencies, including Health and Human Services (that runs Medicare and Medicaid), Veterans Affairs, the FDA, the NIH and even the CDC. On the private side, there are many complex mini-systems, including HMOs (health maintenance organizations), PPOs (preferred provider organizations) and the emerging ACOs (accountable care organizations). All of these have their own set of rules and often have their own set of physicians and even patients.
It is this strange amalgam of healthcare systems that has made it difficult to make any meaningful reform. The only real oversight that exists is over the government run sectors. Control over the private sector entities can only really be achieved by Congresses’ mandate to regulate trade- rather than meaningful healthcare policy. It is thus not surprising that most of the programs and initiatives that Mrs. Clinton and Mr. Trump propose (or any proposal up until now for that matter), either have to do with expanding and/or streamlining the government programs, or stipulating minimum coverage requirements and/or employer mandates for private insurance.
The ACA is only one of many such attempts by Congress in the past 20 years, some with arguable successes, and others (like the Sustainable Growth Rate– or SGR- formula) that were spectacular failures. In fact, one recent ‘healthcare reform’ act, called MACRA, passed by Congress last year will likely affect healthcare providers and patients far more than the ACA- but is little known (even by many doctors).
In many ways the problems that plague our current healthcare system are similar to the problems that plagued our banking system at the turn of the 20th century and which prompted the creation of the Federal Reserve. The creation of the Fed allowed for the establishment of a national currency (our dollar bill) and effective oversight of the US economy. It modernized the United States’ financial system and helped it become the world’s predominant economy.
So, can our healthcare system benefit from a similar independent non-governmental oversight board; and if so, how might it work? And more importantly for our candidates, how could we sell such a change to the American people?
The first thing that most would agree, no matter one’s political affiliation, is that lawmakers should not practice medicine. Yet, in the United States, Congress has a tremendous influence over healthcare policy that has grown stronger as public health insurance programs like Medicare and Medicaid have expanded. This, in turn, has led to frequent instances where politics and financial constraints have led to (very) bad healthcare policy decisions.
Establishing a National Medical Board (NMB) based on the Federal Reserve Board would provide a much needed independence to our healthcare system. This NMB would then absorb all the government agencies that deal with healthcare, such as the department of Health and Human Services (that runs Medicare and Medicaid), VA, FDA, NIH, CDC, etc. Advantages of such a move would include a coordinated oversight of the entire healthcare system, significantly reduced duplication of services that now exist between agencies, a unified healthcare system with a ‘national healthcare mission’ and a tremendously simplified method of funding. This funding would come from a single annual healthcare expenditure bill from Congress that would fund the entire healthcare system (rather than the current piecemeal funding of the various components). This would then allow the NMB to give science based priority to the most important healthcare issues and would also allow it to reduce duplication.
As outlined in my book, “EMBRACE: A Revolutionary New Healthcare System for the Twenty-First Century,” once a NMB is established, it will be much easier to oversee the American healthcare system and create a modern infrastructure that allows it to use many of the modern tools that our current system is struggling to adopt.
As for the candidates, there is something for each in this plan. For Ms. Clinton and the Democrats, it would assure true universal coverage from cradle to grave for basic healthcare needs. For Mr. Trump and the Republicans, it will eliminate Medicare and Medicaid (and even VA healthcare), as well as eliminate the mandate that businesses need to provide healthcare.
But in the final analysis, it would be the American people who would benefit from a plan like EMBRACE that would create a NMB.
Gilead Lancaster, MD is a cardiologist and Director of Non-Invasive Cardiology at the Joel E. Smilow Heart Institute, Yale New Haven Health at Bridgeport Hospital in Connecticut. He is an Associate Clinical Professor of Medicine at the Yale University School of Medicine and Associate Clinical Professor of Nursing at the Yale University School of Nursing.
Dr. Lancaster is the author of the recently released book, “EMBRACE: A Revolutionary New Healthcare System for the Twenty-First Century,” detailing the EMBRACE plan that was conceived by a bipartisan group of healthcare professionals who felt that effective healthcare system reform needed to come from healthcare providers.