By Judd Gregg - 04/07/14 06:00 AM EDT
A few facts might help to bring some clarity to the discussion of how we deal effectively with healthcare in this country: its availability, its quality and its cost.
Democrats generally, and those up for election this year in particular, have been trying to distance themselves from, and obfuscate about, the law’s obvious failures.
On almost a weekly basis, the administration is arbitrarily changing the rules that were either written in the original act or issued by the Department of Health and Human Services soon after its passage. During those early days, big claims were made but little in the way of results was evident.
Now, in a breathtakingly deceptive declaration, the administration is touting the fact that with approximately 7 million people supposedly signed up, ObamaCare is a success. Of course, this entirely glosses over the millions of people who are in healthcare limbo as they try to figure out what their coverage is, who will provide it and at what cost.
Most important, it is now rather obvious that ObamaCare is not going to insure a very large share of the previously-uninsured population.
The defects of the law do not begin and end with the taking away of insurance plans from people who were previously happy with those plans. ObamaCare will also cost an extraordinary amount of money because of the new federal subsidies and mandates both in the exchanges and in the states’ Medicaid programs.
Further, it will significantly undermine the cause of delivering high-quality, outcomes-driven healthcare at a sustainable cost. This goal, now receding into the distance, should have been the overriding aim in the first place.
The entire effort to reform healthcare should have started with a look at the statistics that are driving the issues of cost and quality and then used those facts to design better delivery systems.
One-fourth of all healthcare spending revolves around 1 percent of the population. One-half of all healthcare spending is driven by less then five percent of the population. Ten percent of the population accounts for 65 percent of healthcare spending.
On the other side of the coin, half of all Americans spend less than $240 per year on healthcare.
It is fairly obvious from these facts that a broad-brush, top-down, nationalized approach such as Obama- Care does not properly address the questions of cost or quality. It concentrates control in the hands of a few, self-anointed government officials who claim to have most if not all the answers. In fact, they do not even ask the right questions.
One group of patients, those with full-onset chronic diseases such as cancer, stroke and Alzheimer’s, require an average of $35,000 per year to care for. If better and more efficient care of these individuals could trim their costs by 20 percent, $300 billion would be saved annually in healthcare costs to the nation.
This is a doable goal if the delivery system is built with a focus on this group of people. Instead, ObamaCare gives equal emphasis to everyone.
The primary goal should be to give better quality to those who are sick at an affordable price. The focus should not be on the uninsured or on supplying the general population with coverage they do not need. It should be on creating centers of excellence at the delivery level that get the best healthcare to the chronically ill at the most affordable price.
There are a number of ideas of how to do this, including a better working relationship between the frontline doctors and the specialist; better communication with the patient and their support system; and looking at how different procedures are priced relative to outcomes.
Reaching this goal also requires a much more aggressive effort to deal with end-of-life issues — a subject which it is extremely difficult for our political system to address in a manner that does not lead to a shouting match.
The uninsured need coverage, especially when they have unpredictable catastrophic events like falling off their motorcycles. But this can be handled without requiring the expense and dislocation generated by ObamaCare and its mandate to, in essence, cover everyone equally.
In any event, ObamaCare has dramatically failed to even achieve that purpose. Rather, it has caused a massive misdirection of effort.
It is an opportunity missed. This is almost inexplicable, when you have facts that point the way in such a stark and clear manner. Unless, of course, your ultimate goal is not a better healthcare system but a larger and more invasive central government.
Judd Gregg is a former governor and three-term senator from New Hampshire who served as chairman and ranking member of the Senate Budget Committee.