From Obamacare to Republicare

by Tom Campbell, Executive Producer and Moderator, NC SPIN, March 9, 2017.

If we can allow ourselves to tune out the many distractions coming out of Washington (and Raleigh), we might be able to tune into the number one domestic issue of our time – healthcare. Even though 20 million more Americans now have health insurance, most agree the Affordable Care Act (Obamacre) has flaws. It might not be the “disaster collapsing around us,” as some claim, but ACA needs to be reworked. Obamacare has neither significantly improved outcomes nor lowered healthcare costs as envisioned and, despite the mandates, too many remain uncovered.

Republicans ran on a platform to repeal and replace Obamacare, a good sounding campaign pledge but a much more difficult task than they envisioned. Give the House Republicans credit for putting the issue back on the table, but this week’s draft legislation seems to be acceptable to few; it will not lower costs or assure access and is almost guaranteed to result in many losing coverage. The big beneficiaries will be insurance companies. If Republicans can agree on healthcare reform, something that seems unlikely at this moment, count on their plan being hung with the moniker “Trumpcare” or “Republicare,” because they will own it, much as the former president did ACA.

Republicans have the right problem but, so far the wrong solutions. The only plausible and workable healthcare plan we have seen came out of the 2010 Simpson-Bowles Fiscal Responsibility and Reform Commission and deserves resurrecting and reconsideration. Former Senator Alan Simpson and former UNC President Erskine Bowles spent a year in hearings, researching data and hammering out proposals. Bowles outlined the basics of the plan in a 2012 Healthcare Forum for NC SPIN.

Some 18 percent of our Gross Domestic Product is consumed by healthcare, about twice as much as any other country, even though 25-50 other nations have better health outcomes. At its essence healthcare has become a cost-shifting program where every American receives healthcare, whether by an employer or self-paid insurance plan, Medicaid, Medicare or through mandated hospital indigent care. We need to recognize that one way or another taxpayers subsidize healthcare for an increasing percentage of our population. Like it or not, healthcare has become a right of our citizens.

Instead of taxpayers providing Cadillac coverage to everyone, Erskine Bowles says, we need a “pretty good Chevrolet” plan for basic care. Nobody should get first dollar coverage; everyone should have some skin in the game and absorb some of the costs. Everyone should have a patient-centered medical home, focusing on quality rather than quantity of care, a model that would require more primary care physicians, nurse practitioners and physician assistants.

If we are going to provide healthcare to everyone we must bring down costs of prescription drugs. Simpson-Bowles says nobody would receive name-brand drugs unless a generic drug wasn’t available. Tort reform is also necessary, so that doctors spend less time practicing defensive medicine. Finally, we must have some honest discussions about end-of-life care, not “death panels,” but recognizing that the most expensive healthcare usually occurs in the last few months of a person’s life.

The ultimate solution probably won’t make anyone totally happy and everyone will have to compromise, but it is clearly time to accept the realities and find workable solutions. Simpson-Bowles is better than anything we’ve seen to date.