he highly contentious and volatile presidential election has kept us too busy to actually discuss what the next president is going to do about the crisis in the American health care system. This $3 trillion line item in the US economy is suffering from runaway cost inflation, collapsing insurance markets, and underwhelming outcomes. As a former executive of a large safety net hospital, I can tell you that this is a big deal.
Several states, pessimistic of a viable federal fix, have tried to craft at least stopgap solutions, mostly around access to care and, to a lesser extent, around cost and quality of care. None have succeeded. It’s likely that Colorado’s effort, on the ballot next week, is headed in the same direction.
The Institute for Healthcare Improvement’s Triple Aim Initiative has identified an ambitious but logical framework for health care reform. Its three key goals include improved patient experience and quality, improved health of populations, and reduced cost.
The federal Affordable Care Act (ACA), rolled out in 2010, improves access to care. But that’s just one aspect of quality. Since then, the federal government has reached a stalemate, unable to address the other areas fundamental to comprehensive health care reform which were not a part of the ACA.
Washington, it seems, has completely lost the ability to address complex problems, especially when it requires working across party lines. The lack of cooperation has paralyzed efforts to improve access to health care. Even worse, it thwarts discussion on the other important components of the Triple Aim: quality, cost, and population health.
Several states have tried to fill this void. The idea of state-provided universal single-payer health care coverage has been floated in Illinois, California, Hawaii, New York, Massachusetts, Minnesota, Montana, Pennsylvania, and Oregon. It failed to pass in all of them.
In a bipartisan effort, Vermont passed a universal coverage, single-payer system in 2011. But after three years of exploratory discussions, it abandoned the initiative because of skyrocketing costs and tax requirements.
In Colorado, where I live, voters will pass judgment on Amendment 69 on Nov. 8. Its passage would dismantle the current health care system and create a $38 billion political subdivision called ColoradoCare that would enshrine universal health care coverage system in the state’s constitution.
ColoradoCare should serve as a cautionary tale to other states seeking to fix the health care problem. The massive cost and the breathtaking scale of the bureaucracy it would create have it sucking wind at the polls, with 67 percent of voters opposed to the amendment and just 27 percent supporting it, according to a recent Magellan poll.
Adding to the amendment’s unpopularity is that its largest funding source would be a new 10 percent tax on every Coloradan’s payroll income, as well as on interest from savings and dividends from stocks, capital gains, and some retirement income.
Putting ColoradoCare in place would double state spending overnight and give Colorado the highest income tax in the nation, making us immediately non-competitive in attracting businesses to locate in the state. It would also hurt startup hubs in places like Boulder, which are the state’s growth engines.
If ColoradoCare was a private corporation, it would rank 80th on the Fortune 500 list — bigger than Nike, American Express, Sears, or McDonalds. And yet many details, including the actual leadership, would need to be worked out. Can you imagine asking for funding for a company of that size without knowing the management team?
As a physician, health care executive, and entrepreneur, I’m a proponent of universal health care. But too many attempts to fix health care are poorly conceived and lack the kind of delivery model innovation that will be required to manage the feat of covering all Americans, delivering superior outcomes, and managing costs.
Success is possible. But we need imaginative, bipartisan thinkers to generate a plausible federal solution. This would relieve the states from having to fabricate their own insufficient, piecemeal legislation for health care. Any program put forward should focus on the Triple Aims of health outcomes to improve overall population health and reduce the aggregate cost of health care.
Health care policies can’t be developed in isolation, since 70 percent of health outcomes are dictated by social determinants of health and related health behaviors, such as availability of safe and stable housing and access to quality education.
Ideas for moving forward can be borrowed from other industrialized nations with better health outcomes than ours, such as the United Kingdom, Switzerland, and Sweden. The federal government can create a better, more flexible health care framework around which states could innovate. This means either creating new policies or removing old ones that are barriers for delivering more efficient, cost-effective care. Examples include supporting new ways of delivering care, seamless data sharing, and unique payment models.
The federal government should take the lead on putting forth a comprehensive and coordinated effort to address our current health care crisis. In doing so, it must address quality, cost, and population health. If it doesn’t, we’ll see more wildly misguided simple-solutions-that-aren’t-really-solutions to complex questions like what to do about health care in America.
Kenneth T. Bellian, MD, is a Boulder, Colo.-based physician, health care executive, and digital health entrepreneur, as well as a fellow in the Colorado Governors Fellowship Program, which seeks to train and attract business and nonprofit leaders to public service.