If Obamacare Falls

Until last week, the government's confidence on the constitutionality of the Patient Protection and Affordable Care Act (PPACA) seemed all but certain.   Now, they're not so sure it might stand. 

Of course, most American's are wondering: "Okay, if it gets repealed, then what?"

First, it is unlikely things will change right away.  Many of the changes we've seen in health care with funding of the electronic medical record and forcing the collaboration between doctors and hospitals were created by the earlier economic "Stimulus" package funding, not the PPACA.

But for those of us involved in health care, a whole host of opportunities arise for our health care system if the PPACA falls.  It is no secret that the biggest problem of our health care system is its rising cost relative to inflation.  While the constitutionality of Obamacare may become its immediate undoing, the continued runaway costs that were not managed by the creation of such a gigantic new system would have eventually destroyed our health care system (and perhaps our economy) anyway.  Already, new 10-year cost estimates far exceed original estimates.

If the PPACA is struck down, legislators will have an opportunity to address the problem of cost sustainability head-on to our health care system.  The current health care ruling, if it plays out as anticipated, will need a viable, solvent alternative. The alternative will be a challenge to construct as special interests spend millions to lobby our legislators.  But Congress should be increasingly aware that they are viewed by most Americans as divisive and largely ineffective; this could be a chance to change that perception for there is much both sides of the aisle can agree upon.    They understand the need for affordable health care for the most needy.  And most understand the cost conundrum must be addressed.

So what should Congress do?

In many ways, the answer might be easier than we all think: 

Fix what's broken first. 

Rather than creating a new, larger government health care system based on an 2700-page nearly unreadable health care law that creates at least 115 new agencies and winds between countless government agencies and disconnected bureaucracies, we should move to fix what's broken with Medicare and Medicaid first with an eye toward fixing what matters most to Americans.

If we've got waste, fraud, and abuse to the extent we are told, then fix it.  We don't need new agencies to do so.

Admit there are limits to what can and will be paid for, set a budget, and stick to it.

If we care about our kids being uninsured, then fix it.

If care about people with pre-existing conditions not being insured, then fix it.  But be honest with limits.

If people with sufficient means aren't contributing enough for their health care, fix it, but don't restrict what care those folks can obtain on their own nickel.

If doctors are saying they are overburdened with documentation requirements that don't improve patient outcomes or safety, then fix it.  Stop perpetuating wasteful documentation mandates that add nothing to patient outcomes.

If we care about families going broke from health care expenses, then fix it.  As a corollary:
if people don't know what things cost until it's too late to avoid bankruptcy, then fix it.

If costs are too high for medications, then fix it.  Don't allow direct-to-consumer advertising and save a billion dollars (or more) for consumers.  Open overseas markets to generic medication manufacturers that can prove the quality of their product.  Things like this make patients the priority, not special interests.

If we don't have enough people caring for our population, then fix it.  But move with caution - quality must be maintained: consider the costs of truncating supervised clinical training in favor of producing doctor mills.

If prices for materials and goods are held artificially high by government's fee payment schedule, then fix it.  Legislators should ask themselves: do we really need pharmacy benefit managers and group purchase organizations that add no value for the patient?    Can you say "i-n-t-e-r-n-e-t?"

Rather than trying to fixing exerything that ails our system all at once, take it piece by piece.  Vet the issues openly rather than behind closed doors.  Since prices are the priority, make prices for elective procedures and medical equipment available online to patients AND doctors.   Patients must be the priority to our new initiatives, not special interests.  Most of all, make the lower cost of health care and quality of health care the priorities and stop promising that the quantity of care we provide can remain unlimited to all. 

Improvise.  Adapt.  Who knows: we might just overcome our current health care crisis bit by little bit.

But the one thing that Congress should absolutely NOT do is kick the health-care-cost can down the road any further.  Otherwise, any new measure to preserve our health care system will be just as worthless to the sustainability of health care and our economy as the paper they're printed on.

-Wes