Andrew L. Pecora, MD
Bill Murray made us all laugh in Groundhog Day
with his portrayal of a TV weatherman named Phil Connors who was forced to suffer the same day over and over again until he became a better person. We as a nation appear to be forced to relive the political acrimony surrounding the Affordable Care Act (ACA). What did our political leaders think would happen when the ACA was approved without bipartisan support?
Now, with a new political party in power, there will be another partisan turn of the wheel. It is predicted that, in the process of finding a replacement for the ACA, millions of Americans will lose their healthcare. However, the ACA was founded on a misguided premise: mandating young people to buy insurance who did not need it to pay for those, usually older, who did. It should be clear to all Americans, without the need for an economics degree, that when you add in the current national debt; the financial unsustainability of Medicare, Medicaid, and Social Security in their current forms; the need to cut taxes to spur economic growth; and the apparent need—hopefully not—to spend more on our military to protect our nation, something has to change or there will be plenty of shared economic suffering.
So what form will the ACA replacement take? Let us review the sound bites:
• Raise taxes on the rich—this sounds good but even if taxes were raised to 100% of current income it would not fix the problem.
• Price controls on drugs—we tried this before but it just does not work, and if it did, why would investors continue to invest and companies assume financial risk to give us better drugs?
• Pay doctors and hospitals less—this has happened and the early returns are not that good. Many doctors are burning out and an increasing number of hospitals now operate at negative margins.
• Mandate insurance for all—been there done that. It was not accepted.
• Intensify efforts to substitute cheaper drugs and shorten the length of care—the trend currently is an increasing number of costlier drugs and diagnostics that improve outcomes.
So, how do we get out of Groundhog Day
and avoid shared suffering?
The day after Pearl Harbor was attacked, leading to our involvement in World War II, my father, like many other young men, lied about his age in order to help defend his country (he was 17 not 18). The sense of shared responsibility that prevailed back then appears to be lost. How about replacing Groundhog Day with everybody—young and old, rich, and poor—chipping in like a previous generation did, to save our nation. We should raise the minimum age for Social Security benefits by 2-3 years, means- test Medicare recipients and implement Medicare benefits in a gradual fashion. Let’s make insurance portable and available across state lines. Have a health insurance product for everyone that is mandatory but priced according to age and income. Focus on eliminating unnecessary care (thought to be 5% of GDP) instead of attacking medications and procedures that improve outcomes. And finally, pay doctors and hospitals more but hold them financially accountable for value. This is just a short list of what can be done if we want to share the responsibility. In the movie, Phil Connors eventually gets out alive after repeating the same day over again. Will we?