Trump's health care storm could end with a rainbow

Trump's health care storm could end with a rainbow
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As the leader of a Top 20 academic medical center and safety net hospital, it would be easy for me to join the cacophony of voices criticizing President Trump’s actions on health care over the past few weeks. But I have decided that allowing insurers to cross state lines and ending cost-sharing subsidies may be exactly what the doctor ordered.

Before you ready the hate tweets, let me explain.

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The Affordable Care Act gave a lot more people access to health care, but it left in place a fragmented, expensive, duplicative, inequitable and occasionally unsafe health care delivery system. ACA supporters hoped the law would transform the health care delivery system.  What the law did is leave us $1.00 to pay for $1.25 worth of health care.  

The debate thus far has been about what to do with that extra cost — Democrats seem to want to give everyone 25 cents more, while Republicans support moving that quarter around in ways that that could reduce access to care. To date, no one has proposed to create a new model that makes the current, unsustainable one obsolete.

This week’s actions by President Trump represent the tsunami that many of us in the health care system have been waiting for, a storm that forces everyone – hospitals, insurers, pharma, doctors, and others – to think beyond their self-interest. It can take a natural disaster to force a serious discussion about new models and create a level of urgency that almost never follows a near-miss.

In much the same way, the breakdown of the ACA insurance markets, the failure of repeal and replace and the continuing unsustainable increase of health care costs have been the hurricane that caused some damage but didn’t score a direct hit. Contrary to popular belief, President Trump’s moves may not be crazy at all.

The major health care stakeholders will entertain limits for everyone but themselves. It’s time to look in the mirror and view President Trump’s executive order as the hurricane making a direct hit on health care. The executive order means the status quo is unsustainable — it's a message to Congress and the major stakeholders that they'd better do something, and it requires each of us in the health care ecosystem to address what we can do to “clean up” after the hurricane and provide better access, quality, patient experience and cost.  

In his book, “Medicine’s Dilemmas: Infinite Needs Finite Resources,” William Kissick described an “iron triangle” of cost, access and quality in health care. An increase in one angle of the triangle would force a decrease in another. But the current system is based on the myth that we can increase access, increase quality and decrease costs without painfully disrupting health care, without contorting the triangle. The new model, one that we are implementing at Jefferson Health, takes on a different shape altogether, built around the patient experience starting at home.

We must finally force health care to join the consumer revolution through greater utilization of technology that moves the delivery of care from the hospital to the home. Imagine if you needed a different ATM card for every state you travelled to — that’s health care in 2017. But with telehealth and other technologies, we can provide health care across state lines without needing different licenses for every state.

As an obstetrician, I view health care reform in the same way I advise parents in labor — it’s long, it’s painful and you don’t really know how well you did for about 21 years. The health care system has long needed an inciting event to divert us from our current unsustainable path. Following “Hurricane Donald,” we have an opportunity to rebuild a new model of American health care around innovation, population health, patient provider partnerships, consumer health and disruptive technologies.

We need a 9/11-style commission involving Democrats and Republicans to assess what health care looks like “the morning after.” We need people on the ground willing to transform what they do to strengthen the system as a whole. Were that to happen, someday we might look at the events of the last few days as producing a rainbow at the end of the storm.

Stephen K. Klasko, MD, MBA, is president and CEO of Thomas Jefferson University and Jefferson Health.