Now that he has responsibility for the American health care system President Donald Trump — who will address it in his primetime address to Congress on Tuesday night — says, “Nobody knew health care could be so complicated.”
Just about everyone who ever used the system knew it was really complicated, but as tempting as it may be to mock him, at least his comments reflect, perhaps, a realization that 20 million people depend on the care they receive thanks to the Affordable Care Act.
The ACA isn’t perfect, but it did create a baseline of coverage and care that made life seem a little less uncertain. Sudden disruptions can lead to real pain, suffering, and even death. Any ACA replacement offered by Trump and the Republicans needs to address the anxiety that millions are experiencing about the fate of their healthcare and embrace a determination to connect consumers, who have been in the dark for too long, with better advice and technological tools to improve their care while creating a fairer marketplace.
Today the Republicans who want to change health care are encountering protests similar to the Tea Party demonstrations against President Obama and the Democrats. The resistance from those who want to keep the ACA has alarmed some representatives. A case in point is Rep. David Brat, a Republican member of Congress from Virginia. In recent weeks, protesters — most of them women –have made it their business to show up wherever Brat appears in public and noisily demand that he protect their access to health care. When Brat subsequently whined about that female constituents were “up in my grill” about health care, he found himself widely mocked on many websites.
As Brat and other Republicans are finding out, health care is essential to every American’s life and is thus a core concern for voters. It is also huge part of the economy ($3 trillion and growing) and it is one of the few places where we each must entrust ourselves to the expertise and good intentions of people we may barely know. Every person living with a life-threatening or life-limiting diagnosis understands that the system must be fair, trustworthy, and supportive.
The good news for those who suddenly find themselves in a position of responsibility on health care policy is that they can fashion improvements if they use the best that’s available from business, technology, and the government to improve patients’ ability to communicate with their doctors and to interact with the health care industry. Policymakers should consult and engage experts in artificial intelligence, entrepreneurs, and innovators who understand how to protect consumers in markets that sell complex services. Americans need to be protected if they are going to navigate the complex landscape of health care, but the means to do it are at hand.
A fair marketplace
As anyone who purchased coverage before the ACA knows, health insurers once enjoyed marketplace advantages due to the arcane terms and complexity of the products they sold. The ACA has put buyers and sellers on a more even footing.
If the pro-business GOP wants to use the free market to provide health care, they must include in their quest to repeal and replace the ACA a plan to encourage the development of Health Insurance Advisers (HIAs) that provide consumers with clear, unbiased advice and connect them with technological tools to communicate with their providers and insurers alike.
HIAs could build services based on the kind of technology already used by Facebook, Google, IBM and others to minimize labor and increase the efficiency of delivering straight answer to the public. IBM is now developing this kind of help in the area of diagnosis where it will provide early warning for patients with breast cancer and other diseases.
In addition, insurers should be required to register their plans with insurance advisers who could then crunch the data and respond to inquiries from people shopping for coverage. Fees for this service could be based on the cost associated with providing it, with in-person counseling coming at a premium. The cost could be added to the payments made for policies and, if lawmakers choose, subsidized for lower-income participants.
HIAs could ease the transition away from the ACA, but would resolve only one aspect of what makes Americans anxious about the future of health care. The other parts of the equation relate to how patients interact with their doctors and other providers and access information about their options.
Better treatment information
What good is it to know the options for care if you lack the information required to make a wise choice? Is depression best treated with medication? Talk therapy? Lifestyle changes? A little bit of everything? How about cancer care? How do we know if our doctors and hospitals provide the most effective treatments?
In a world where even physicians struggle to keep up with new developments we cannot expect every patient to find his or her way to the ideal choices. Entrepreneurs, established tech companies and even non-profit organizations have the capacities to fill the gap; why not develop applications and web-based programs that would walk people through various options for care and provide recommendations based on an individual’s unique history? With the right training, professionals should be equipped to demystify the options and assure people they are making informed choices.
Imagine if the computing power available at Google, were put to work on medical decision making. People who feel comfortable with using this kind of artificial intelligence could use it to review their records and test results and consider the likely outcomes associated with each plan of treatment available. Those less comfortable with technology could combine it with human help from medical students, nurses and other caregivers in a network that could be accessed on an as-needed basis.
Opportunities for tech
Few in medicine dispute the idea that a combination of high-tech and hands-on medicine will provide the best outcome for the most people. Unfortunately Tom Price, who is Trump’s secretary of health and human services, is widely rumored to be a critic of electronic health records. We would all be better off if he could recognize electronic records as is a huge resource that could is already making care safer, more precise, and more cost effective.
Beyond the improvements already achieved, the electronic record system can go further to plug caregivers into a world of information that will allow them to explore their patient’s history, select better treatments, and avoid complications, all in real time as advisories pop up on their screens. For patients, the system offers the possibility of more direct engagement in their own care.
Perhaps the most popular parts of Obamacare are its expansions of medical services: coverage for vaccines, routine cancer testing and mental health, which reduce medical costs over the long run. The ACA also made a start toward providing quality oversight over healthcare providers. The most visible part of the quality improvement part of the ACA is the Medicare Star Ratings system, which gives Americans a way to judge the quality of care they could expect from hospitals and home care providers.
By the government’s own estimates, better care meant that 50,000 after-hospitalization deaths were prevented in just the first two years of the ACA. Preventative medicine combined with communication and technology empowered patients and saved saved lives.
The spirit of this achievement should guide the work ahead to improve the quality, coverage, and efficiency of the health care system. Without better information and communication tools for consumers, policymakers will not succeed in fixing the problem. And failure would produce a political disaster for the GOP and be unnecessarily painful for the entire country.
