(Editor’s note: The following is the last in a three-part series on the state of healthcare in America from the inside looking out. In the first two parts, we discussed how the healthcare system is an anomaly, and how to improve the quality of care.)
No matter the ultimate fate of the American Healthcare Act introduced on Capitol Hill this week, it is clear that politicians in Washington will hardly be able to fix everything that is broken in the nation’s healthcare labyrinth.
As discussed in the first two parts of this series, the healthcare system is an anomaly. It has operated outside the normal bounds of the marketplace. It lacks transparency and accountability. In most cases, the industry either over-serves the market by purchasing an excess of extremely expensive equipment that is under-utilized, and for which the consumer pays, or it under-serves communities with an inadequate quality of care driven by the thirst for profit.
So what changes would be made by those who actually administer healthcare at ground level?
Liberty Nation put that question to Alan Kelly, who for a dozen years functioned at the highest levels of legal, risk management and corporate operations at HonorHealth, the largest health care concern in Arizona, and was formerly Chief University Counsel at Thomas Jefferson University in Philadelphia.
LN: If you were given control of the nation’s healthcare system, tick off the items that you think would most benefit the consumer.
Mr. Kelly: Most hospitals are non-profits. I would make those non-profits earn their ability to be tax-exempt. I would make for-profits do some of the same things. I think that we need transparency. I think you should be able to go online and actually look at their quality, look at what their patients have to say about them. That is not the case now.
LN: But what if they’re not transparent? Then what happens to them? They’re already a nonprofit.
Mr. Kelly: Well, I think that there’s two ways to approach it. The first is to make them pay a part of that tax they are not paying, for under-performing and the things they’re not doing. For example, if a patient satisfaction survey came back in a quarter and 15% of the patients were not satisfied with the treatment or care, then I think the hospital, whether it’s nonprofit or for-profit, should be legislated so that they would receive 15% less reimbursement. Then you will see an incentive to drive quality of care, rather than profit. You will see efficiency rather than duplicity. I think you’ll begin to see a transformation of an industry that has lived in the cradle of isolation.
LN: A big part of President Trump’s plans and those of the Congress, is a tremendous expansion of health savings accounts. The target is to get more individuals to have these personal accounts which they can build up over the years and use for anybody in their family. They can keep the money in their own accounts and then combine that with catastrophic coverage where you have a six, eight, ten thousand dollar deductible so that you’re covered in the event of extreme conditions. How much, in your opinion, will an expansion and an emphasis on health savings accounts help to turn around this health care system where the costs have skyrocketed?
Mr. Kelly: I think you’re on the right highway. Unfortunately, we need another lane. If you have a health savings account, that’s great. You have the ability to control and to shop, but when you don’t have a provider that’s willing to disclose, then it’s sort of blind. You’re missing that extra component that you need. What you need is transparency. I think we’re on the right road. You are on the right road in asking that question about health savings accounts because it’ll give you the ability to shop, but if no one is telling you what their rates are, how is that really going to help you in the long run? Let’s stay on that highway, but we need that extra lane to make it work.
As Mr. Kelly has emphasized, there are more reasons for the enormous cost of health care than meet the eye. He believes, based on his thirty years in healthcare administration, that transparency is critical, and that the industry’s “cradle of isolation” must be subjected to the same market forces as the rest of the consumer economy.
There is significant collateral damage from the cost of healthcare. The problems with price and availability of health insurance have led millions of people to remain in jobs they don’t particularly like solely because of the health care benefits offered by their employers. Think about the sum total of lost productivity associated with all those workers who are unfulfilled or dissatisfied with their positions.
Many on both the right and the left are dissatisfied with the American Health Care Act – for differing reasons. One side believes the new legislation is nothing more than Obamacare light and represents an enormous missed opportunity to completely dismantle what Obama built. The other side hates the new bill because it does not mandate health insurance for every single person in the country – whether they want it or not.
But there is no denying that this bill represents significant reform. Tax credits replace subsidies. Power over the system largely devolves from the federal government to the states and, as explained here on Liberty Nation by Dan Ingram, the mandate of universal coverage is replaced by a requirement for continuous coverage, thus attaching a cost to people planning to purchase insurance only after a major medical incident or illness.
No matter your opinion of this new legislation, our discussion with Mr. Kelly these last three days reveals a fundamental truth: to fix the troubled healthcare system in this country, we need to start as much from the bottom up as the top down.