Over the last week, I’ve been asked many times, “What effect will the presidential election have on our work?” Truthfully, I don’t really know. What I do know is that every American wants a healthcare system that is less costly, delivers better health outcomes and is more focused on the patient. Republicans and Democrats realize that we cannot return to a system that only financially rewards the number of services provided without regard to whether or not those services actually helped the patient and were provided in the most efficient manner possible. The move toward value is well under way and payers are not reverting to the old ways that had healthcare costs rising by 7-10 percent annually. Also, Republicans and Democrats know that even though we have made progress, we are still spending 40 percent more per capita on healthcare than any other country in the world and our industries are less competitive because of this.
The Affordable Care Act (ACA, Obamacare), in my opinion, has been very successful. More than 10 million Americans now have health insurance who did not have it before. People who were born with a disease now can buy insurance when they couldn’t before. Children can stay on their parents’ plan until they are 26 years of age. Medicare has seen the lowest annual cost increases in decades, and employers have benefited from lower increases to their plans.
The one area where the Act needs improvement is in controlling premium increases for individuals buying insurance on the exchanges. Before the ACA, people who were already sick (like someone I know who was born with epilepsy) could not get health insurance. Therefore, the price of insurance for individuals was lower than it is now because the insurance companies were only insuring well people. The ACA “mandates” that everyone not covered by their employer, Medicare, the Veterans Affairs or Medicaid buy insurance. You need the healthy people in the plan to spread the cost of the people with a disease over more policies to keep the price low. Well, too many healthy people are not buying the insurance and, therefore, the price has gone up significantly. This is the classic “chicken and egg” situation. People are not buying the insurance because the price is too high, and the price is too high because people are not buying the insurance. Medicare works pretty well for America’s senior citizens because it is paid for by the Medicare tax, and the younger beneficiaries don’t consume much while the older ones do. Medicare doesn’t make the sicker patients pay more. By the way, Medicare only spends about 8 percent on administration, the other 92 percent goes to pay for care. Before the ACA, private insurance companies were spending 70-80 percent on care and the other 20-30 percent was going for administration and profit. The ACA limits the percentage for administration and profit to 18 percent. If the act is repealed, this limit will go away.
Homeowners insurance wouldn’t work if you could wait to buy it until your house caught on fire. The same is true of health insurance. The risk must be spread over the entire population, including the healthy, for it to work. So it’s the “individual mandate” part of the Affordable Care Act that isn’t working well, and everyone agrees on this.
How will the new administration deal with this? No one really knows. But it is clear that we must continue to work to create a better system. We in the GBMC HealthCare system must deliver even better health and even better care at even lower cost by driving out the waste. We must educate citizens on the facts. We must make prices more transparent so it is easier to see one source of the waste in healthcare. We must recommit to working both in our state and with the new federal leaders to deliver better value to the American people.
Please join me in celebrating GBMC’s outstanding Nurse Practitioners (NP) this week. Across our nation, there are more than 220,000 NPs who provide care to millions of Americans.
We have excellent Nurse Practitioners working in our hospital, in our physician practices, and in Gilchrist Services. They help us reach our vision of a patient-centered system of care every day. Please join me in thanking them this week!