Who Should Control the New Healthcare System?

As I write this, the current attempt by the GOP to overthrow the Affordable Care Act (ACA), known as the Graham-Cassidy bill, seems to be heading for the health policy cliff.  Since the beginning of 2017, several attempts have been made by lawmakers to replace the ACA, which most experts agree has done anything but make healthcare more affordable and accessible.

In the latest bill attempting to reform the U.S. healthcare system, Bill Cassidy, MD (R-LA) and Lindsey Graham (R-S.C.) created the bill bearing their name. The unique characteristic of this piece of legislative art compared to its forerunners is that it would transfer administration of the healthcare system to state governments rather than the federal government. Each state would receive a block sum of money from the federal government and they could do whatever they wanted with healthcare delivery inside their own borders. Certain subsidies would be cut, such as federal funding for Medicaid programs. Under the ACA, Medicaid expanded and insurance companies rolled out "exchanges" to theoretically offer "affordable" options to the American people.

While I and many doctors feel this bill is a bad, if not harmful one, there are some doctors who disagree.  These doctors say that by turning the reins over to the states, doctors and their societies would be part of the team reforming healthcare. They feel they will have more voice at the state level than they do at the federal one and expect our concerns would finally be heard.

To that I ask, aren't state politicians the same ones that are currently voting on this as well as other ill-fated healthcare bills? I don't expect them to suddenly do the right thing and seek the input of medical professionals and patients. Plus, insurance companies and big pharma will still control most of the healthcare dollars so I expect would exert the most influence.

The politicians claim the Graham-Cassidy protects those with pre-existing diseases, a huge concern of the American people and physicians. But, this protection is only in theory because states would then be allowed to determine what constitutes medically necessary coverage and insurance companies will still determine premiums, deductibles, and coverage determinations. Essentially, these big for-profit companies will continue to operate as they are with little oversight or transparency.

The American Medical Association (AMA), as well as many large medical organizations, issued a position statement against this bill stating that it violates their principle of "First Do No Harm." When subsidies that were provided to help people get health insurance coverage are suddenly slashed, what will happen to those who gained coverage under its auspices? They will become uninsured. This bill will also do away with the federal mandate so people will not have any incentive to purchase unaffordable insurance with narrow networks. When the number of uninsured rises, so will self-rationing, which we are already seeing due to high deductibles.

The politicians in D.C. may continue to rehash their "repeal and replace" agenda, but they will continue to fail because they are not acknowledging the fact that health insurance does not equate to healthcare. This proposed legislation would create a monstrous unaffordable and hard to access system that will harm many patients. And it will not be only those with pre-existing conditions, but those also who cannot afford the exploding costs being foisted onto them.

What we have now is mere political posturing with no attempt at true reform. What we need is to address the true dysfunctions in our current system, which includes unaffordable care and limited access. We need to address the fact that pharmaceutical companies hold a monopoly over the drugs they produce and the system has little choice but to pay in order for patients to survive. Also, insurance companies act with little transparency and regulation. They are free to deny medical tests and treatments based on cost alone and bear no accountability for the actions.

So, who should control healthcare reform? Not the ones who do now and true reform will never happen unless those who see the real problems are invited to the table: healthcare providers and patients.