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August 28, 2019

Fixing our health ecosystem will require a courageous leap of faith.  

“Most observers agree that the US healthcare system is expensive, provides variable quality and leaves many without coverage. The policy challenge is that there is little consensus on how to approach reform. Many proposals assume that systems appearing to work in one nation can be transferred into another or, alternatively, that only minor tweaking of an existing system is possible. The former approach ignores fundamental social, political and legal realities, and the latter ignores the potential for increased benefits.”  

These words, from the Institute for Health Policy Studies, University of California San Francisco, paper What Works and What Doesn’t Work Well in the US HealthcareSystem, describe today’s state of affairs – yet they were published 12 years ago! 

Since then, the greatest change has been the Affordable Care Act, which provides greater access to care for millions of Americans. On all other fronts, we still face staggering deadlocks:  How do we shift our emphasis from sick care to disease prevention? How do we fund breakthrough medications that take years to develop, while ensuring that companies recoup their development investments? How do we provide people with preexisting conditions needed healthcare coverage? From 2006 to 2019, we haven’t made great leaps forward in healing an ailing system or reassuring those with pressing health urgencies that needed care will be available.  

Is there anything that can be done to improve our lot? Absolutely!  Collaboration across administrative silos has led to giant advances that benefit citizens and collective health. That is how the White House and Congress pulled together in 1965 when Medicare and Medicaid came into law. When passed, Democratic held a supermajority. Yet, during the following decades, under both Democratic and Republican administrations, legislators made improvements to Medicare and Medicaid with bipartisan support. They expanded access, considered the needs of children, guaranteed treatment for people with kidney disease and included people with disabilities. 

Policy reflects public consensus and courageous Beltway leadership. Today, few would want Social Security or Medicare rescinded. These benefits are woven into our national safety net. Imagine what could happen next if Congressional leaders across party lines reaffirm greater access to preventive health – regardless of political champion. The output might lead to great progress in addiction, cardiovascular, cancer, diabetes and respiratory diseases by tackling these large cost drivers.

It is important to consider that many Americans welcome the potential of greater access to care. According to the Kaiser Family Foundation, "…nearly two-thirds (64 percent) do not want to see the Supreme Court overturn these protections (i.e., benefits under ACA) compared to half (52 percent) who do not want to see the Supreme Court overturn the Affordable Care Act (ACA) more generally."

In the next two years, there will be swipes at the health decision-maker community – payers, product innovations, providers, and of course, deadlocked policymakers. We know that we must find some common ground among multiple players within our health system to drive change. The challenge is how.

In 1964, when President Lyndon B. Johnson (LBJ) proposed his “The Great Society” policies — including Medicaid and Medicare — he faced stiff congressional and medical community opposition. Yet, despite contentious debate, when called to vote, 70 US Senators and 307 Members of the House of Representatives voted “Yea.”   

More than 50 years later, we hear many of the same arguments leveled at ACA. We can learn from what transpired since 1965 about how to persevere and provide coverage for millions of American residents. As in past generations, the solution will require collaboration, courage and empathy for others. These qualities have often been the drivers to progress and have led to the possibility of people with diverse needs gaining access to care. 

Fixing our health ecosystem will require a courageous leap of faith.  When policy members consider how they would respond if their family member faced illness - empathy - can be a catalyst to healthy collaboration that emboldens hearts to work toward responding to those needs - starting with treatment and championing a better patient experience. 

Empathy was among the drivers of Medicare and Medicaid eventually passing. While LBJ is credited with its success, President John F. Kennedy made healthcare a legislative priority in 1961 and recruited New Mexico’s Senator Clinton Anderson to advocate for the idea of greater medical access.  Anderson suffered frequent bouts of illness throughout his life wrote: Perhaps a man who has spent much of his life fighting off the effects of illness,” he wrote, “acquires…an understanding of the importance of professional health care to all people.”

 

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