Ever since the passage of the Affordable Healthcare Act (commonly referred to even by the President as ‘Obamacare’) the question of healthcare reform in this country has been prevalent on everyone’s mind. The AHA deals mainly with the insurance side of the matter, attempting to rectify what the administration perceives as the main problems with the modern healthcare system: The sheer number of uninsured or under-insured people in the country and the incredible expense that they place on the rest of the population, plus elimination of certain underwriting techniques such as the pre-existing condition clause which, while appropriate from an underwriting standpoint, has been reviled in public.
True reform of the healthcare industry is not just about insurance matters or even arbitration clauses between patients and hospitals, but rather about who, in fact, will be driving the reform in the first place. Who should be running things?
Traditionally, healthcare has three drivers: The hospitals, which provide the staff, equipment, and support—and usually are more business savvy; doctors and other healthcare professionals, who provide the expertise and (one hopes) the compassion to their patients, but who usually have less bargaining power; and the insurance companies, which decide on the coverage under their policies (e.g., scope and often the duration of acceptable treatment). As the former CEO of a health insurer, I am very aware that insurers are the least popular of the participants. They are seen as obstructions to full treatment, administrative nightmares to providers, and they send out the bills. However, the truth is very different.
It’s not really a solution to say that healthcare should be run by doctors. While doctors inarguably are best qualified in general to decide on treatment courses, they aren’t necessarily trained as administrators or business professionals. Costs for care today are incredibly burdensome. It is often thought that providers, if left to their own devices, would make available to patients any treatment at any cost. Insurers try to moderate that tendency. It is a tension that should be healthy, but it has become toxic. Thus, it is my belief that a combined approach is required in order to utilize the respective expertise and to keep the balance of powers. Yes, it’s messy, but so is American government which has its checks and balances.
Hospitals and doctors very much need each other. They complement each other. Instead of asserting one’s superiority over the other, a merging would be ideal, with boards of directors or similar entities shared between business professionals and medical professionals, sharing their experience and knowledge. Insurance companies should be offered a seat at the table as well, in an advisory role, to help inform doctors of the costs of their proposed treatments and other vital data only insurers have access to. We are at the stage now where almost no one can afford healthcare. Costs matter.
Simple, easy solutions almost never work. If the healthcare industry in this country is to rise up to the levels we know it is capable of, it will have to be a team effort that involves the skill sets and points of view of both the people who have to pay the bills and the people who have to provide the best possible care. And that can only be done if this ecumenical group focuses on quality of care and outcomes as the goal and the basis for payment.
