(Editor’s note: The following is the second in a three-part series on the state of healthcare in America from the inside looking out. In the first part, we discussed how the healthcare system is an anomaly. In this second part, Liberty Nation discusses how to improve the quality of care.)
The American Healthcare Act, unveiled this week by Republicans and backed by President Trump, seeks to fix many of the problems that have plagued the healthcare system since the passage of the Affordable Care Act.
The most important element of the new legislation is that it effectively concedes health insurance to be a right rather than the commodity it was before Obamacare. In that sense, the Affordable Care Act has been a success because it has achieved the overriding goal of the leftists who pushed it through: it has created a new entitlement. And it is a truism that, once implemented, entitlements are virtually impossible to repeal. Guaranteed health insurance essentially transformed into a permanent part of American life when Barack Obama won a second term in office in 2012.
But when it comes to the rights of patients, quality stands at the top of the list. And many of the problems associated with the quality of care in the healthcare labyrinth were endemic to the system before Obamacare.
Liberty Nation spoke about this issue with Alan Kelly, who for a dozen years functioned at the highest levels of legal, risk management and corporate operations at HonorHealth, the largest healthcare concern in Arizona, and was formerly Chief University Counsel at Thomas Jefferson University in Philadelphia.
LN: What must be done to improve the quality of care in hospitals?
Mr. Kelly: You don't know what the hospital's quality is because they're really not posting infection rates uniformly. How many cases of MRSA or Sepsis and how many readmissions are there in a particular hospital? That would tell you a little bit about their efficiency. I mean, would you go to Walmart if you knew the particular item that you were buying was defective there or over priced there? You would shop. You're not able to really shop health care at all. This health care industry, for the last four or five years has had to turn around, what I call turning around a cruise ship, to adapt to Obamacare.
LN: Have the adaptations that had to be made by the healthcare industry become a serious impediment to the kind of current health care reform that President Trump and Republicans are talking about?
Mr. Kelly: Well, let me put that in context. There was no more greed from a corporate level, from the presidents and senior vice presidents and vice presidents in an institution the day that Obamacare was passed. You must understand that what Obamacare is, is that everyone is insured now.
LN: More customers.
Mr. Kelly: More customers, but more customers who pay.
LN: Because they have to.
Mr. Kelly: That's exactly right - or you're going to get a penalty. The American Hospital Association is a huge lobby. They said that they were going to take cuts in return for Obamacare, for acceding to Obamacare. Let me tell you, you haven't seen any cuts. What you've seen is bloated, more waste, less accountability, inability to shop. Insurance companies can't go across state lines. As a matter of fact, what you've seen is that it's sort of a shame because if you let the present system continue, it will completely fall apart. It is a disaster.
You can see the clouds and the storm and tornado brewing because major insurance companies, like United, like Cigna, these are very large insurance carriers, have actually withdrawn from states. Now you may have just one or two that you're able to sign up through Obamacare. It's very true what President Trump has said. That is, rates are skyrocketing because what you've done is, you've had less competition and you've mandated people to get insurance. As a hospital executive nothing could make me be happier. Moreover, I really don't have to post my infection rates, my quality, my patient satisfaction. If you're running a business, wouldn't you like to know what your patron thinks about you when they walk out the door?
LN: What are the most important changes you believe should be made in the American healthcare system?
Mr. Kelly: Some of the things would be allowing insurance companies to cross state lines, being more competitive. Making hospitals be more transparent. This is the direction that we have to go. Make them part of the everyday market that we are all exposed to and, moreover, that we often take advantage of. In fact, now we can't. I might go to a hospital that performs one or two open heart surgeries. I might to go to a hospital that has 50 or 60 per month, or a surgeon who has done multiple valve replacements, heart replacements, joint replacements. I want to know what it costs.
LN: You're saying there should be a consolidation of major pieces of equipment such as MRI and CAT scans? That it would be better to have regional centers, three or four places for example, instead of 50, so that they develop that expertise within those particular facilities and will serve as a magnet for people who would naturally choose a place that performs 50 or 60 of a certain procedure per month instead of one or two?
Mr. Kelly: That's a very good question because when you, a consumer, actually go into a hospital, you want to get better and you want to get better fast, or you want knowledge and you want to know what's happening to you. For example, sitting in an emergency room waiting for a CAT scan, I don't care whether they wheel me up to get a CAT scan at four o'clock in the morning or at two o'clock in the morning. The faster you can get it to me, the happier I am. I can tell you this. That If I walked into that radiology department and looked at that CAT scan at two and three o'clock in the morning, there's nobody there. That department is actually shut down and you are sitting there waiting.
So we can see in the analysis by Mr. Kelly that many factors beyond the competence of individual doctors affect your quality of care, foremost among them transparency, efficiency and concentrated expertise within the system. The necessary repairs can not be made by simply passing federal legislation. They must be made on the ground, by each state, each community, each healthcare facility.
In the final part of this series tomorrow, Mr. Kelly will discuss the sweeping changes he would make if he was granted control of the healthcare system.
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