WSHF Board Chair’s 2019 Newsletter
A Three Legged Stool
It’s been said that Americans consider their health care like a three legged stool. The legs are represented by high quality, ready access and affordable services. Let’s propose this model to be the ideal compared to the existing state of health care. Quality can vary across providers or regions resulting in uneven quality of care and outcomes. Access to care may be challenging from scheduling patient appointments to timeliness of therapies and treatments. Many people find health care coverage to be unaffordable with high deductibles, co-payments and insurance premiums.
Health care has proven to be an essential portion of our political environment. Pundits attribute the Democratic party’s majority in the US House of Representatives after the 2018 mid-term elections to concerns about health care. It appears that health care will remain a critical factor in the upcoming 2020 elections. So what’s being proposed by potential candidates to repair the broken three legged stool.
Republicans have been attacking President Obama’s signature legislative achievement, the Affordable Care Act (ACA) of 2010. Attempts by Congress to “repeal and replace” the ACA have largely failed. Instead, the Trump administration and Republican majorities in Congress and at the state level have been reversing portions of the ACA such as the individual mandate. Republican state attorneys general have been bring law suits to invalidate components of the ACA. Last year, a federal judge in Texas found the entire ACA to be unconstitutional based on the repeal of the required mandates. While that judgement has been stayed or delayed pending further opinions by higher courts, the pressing concern is that if indeed the ACA is struck down, millions of people will lose their health insurance. To date, there is no remedy to provide alternative coverage.
On the Democratic side, there have a wide array of proposals from incrementally addressing the gaps in the ACA to “Medicare for all.” It seems that each presidential candidate has a scheme to improve health care. In my opinion, there simply is insufficient information about the candidates’ proposals to make an informed judgment. Questions range from how to pay for health care to the impact of eliminating the private insurance market? How will equitable access to care and quality be assured? These will be essential concerns that candidates will need to clearly address and articulate their policy positions beyond slogans and “feel good” statements.
In the end, do we need to reconsider the three legged stool model? Will we always have unequal access to quality, efficient, effective and affordable health care. And will the model be constantly changing based on which political party in in control. Is the goal of a stable health care system not a reasonable one in view of our deeply divided country?
William N. Werner, M.D., M.P.H., F.A.C.P.