Repeal and… Then What?

We held a retreat last week for the Board of Governors of Northwell Health Physician Partners. Because we have matured as an organization, the agenda was different from recent years. Instead of asking “big questions” about what the group is and should be, we focused on providing information to the Board, and on addressing ways in which we could reduce physician burnout.

Given the imminent inauguration of the new president, and his party’s pledge to repeal the Affordable Care Act, one of the informational sessions was devoted to how the changeover in Washington may affect health care policy. We heard from Northwell Health’s head of government affairs, and from a former senate staffer who now works for a firm that provides our organization with insight into what is going on inside the beltway.

The speakers were knowledgeable and engaging, and I am confident that their description of the incoming administration and of the plans being laid by the new congress was accurate and insightful. It is no criticism of them to also say that I found their description appalling, frightening, and depressing.

Here are a few “highlights”:

  • Despite having 8 years to figure out what brilliant alternative to Obamacare they would like to see, it seems that Republicans have no plan beyond repeal. That means no plan to preserve coverage for the millions of Americans who gained health insurance coverage for the first time because of the ACA, and no plan to preserve some of the universally popular elements of insurance reform that the ACA mandated, such as the elimination of life-time caps on coverage, the extension of parental insurance benefits to children up to age 26, and the ability to purchase insurance despite pre-existing conditions.
  • When asked how it is that the Republican majority had no plan even though they voted to repeal the ACA 63 times the answer was, more or less, that they never had to have a plan when they were in the minority, and now find themselves not unlike the dog who was chasing the bus and now, having caught it, doesn’t know what to do with it.
  • There seems to be no understanding among our elected leaders that the issues driving up health care costs are not a consequence of the ACA, and that repealing it will not magically reduce the cost of care or its consequences, like the growing prevalence of high-deductible insurance plans and narrow-networks.
  • There seems to be more magical thinking when it comes to willfully ignoring the fact that the only way to make insurance affordable in the absence of caps and coverage denial is to spread the risk, either by making everybody buy it or by providing it through some government sponsored program.
  • Tom Price, the nominee for Secretary of Health and Human Services, sounds like he would like nothing more than for medical practice to return not just to pre-ACA, but probably to pre-Medicare, if not pre-history. He may fancy himself a champion of doctors, but he certainly doesn’t speak for me if he rejects the need to move away from fee-for-service to value-based payment, rejects the need to measure outcomes of care and improve care delivery, and rejects the need to assure access to care for all Americans. Someone should also really tell him that the best care is not being delivered by individual doctors in private offices, but by integrated physician-led, multispecialty medical groups.

All in all, it was a picture of ignorance combined with recklessness, a combination that usually ends in disaster.

What do you think?

 

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