Following last year’s very unconventional election and outcome, it’s fashionable to declare that Washington, D.C. is “out of touch” with the rest of the country. Maybe so, but if the conversation so far about health care reform and the future of Obamacare is any indication, the nation’s capital has a long way to go before connecting with the priorities and experiences of millions of patients.
Here’s why: Everyone knows the Republican Congress and new Trump Administration are determined to significantly alter Obamacare – a process both unambiguously describe as “repeal and replace.” President Obama and Democrats are understandably opposed and pledging to fight. They have a slogan of their own warning that GOP reforms could “Make America Sick Again.”
Doesn’t all of this seem depressingly familiar?
Since Obamacare was signed into law in 2010, much – if not all – of the nation’s healthcare conversation has been locked in a stalemate between those supporting and opposed to the new law. Perhaps this was politically inevitable, but it had the very unfortunate net result of freezing out nearly every other aspect of health care policy reform as a near-daily skirmish continued over the basic laws governing insurance coverage.
That’s why patients could truly benefit from a robust health care reform conversation outside of the fight over Obamacare.
How to make meaningful change? Here are three areas of focus in dire need of attention from policymakers, but so far unaddressed in remaking the nation’s current health laws.
Access Above All: It may seem elementary: patients need and deserve ready access to medicines that are right for them. But this premise is under direct assault, and patients everywhere are facing new and unprecedented barriers to access to therapies that are critical to their care
What form does this take? It includes “value frameworks” that limit access to medications based on mathematical formulas on price that often result in the administering of cheaper and less-effective medicine while giving insurers the authority to overrule your doctors’ clear recommendations. Also emerging is “non-medical switching”, and it’s as bad as it sounds: insurance design that literally replaces patients’ medication with something entirely different – without telling them.
To be sure, cost is a realistic concern in health care and resources are not infinite. But patients desperately need health care’s primary preference to be shifted from system maintenance to putting medicine in their hands that can help or heal them.
Infinite Innovation: One hears quite a bit about “innovation” these days, especially at a time when we are already seeing a future of driverless cars and a present time when almost every one of us carries a supercomputer in our pocket that also makes phone calls. But while medical innovation seems no less extraordinary, it seems also significantly misunderstood.
Practically every patient we work with has a special relationship with medical innovation that holds the promise of care and cure for them – or for someone in the future. This may seem counterintuitive to a healthy person, but patients know that while many things can help them, only medical innovation can give them true health and long life. They understand the stakes and they know that their experience is essentially a thread that connects them from previous patients to future ones. Let’s have policies to match this reality.
Real Regulatory Reform: This is perhaps not so much a new idea as it is an old problem. The absurdly long drug-approval process not only makes it difficult to access new therapies, but what we call “new” cancer treatments are often 8 to 10 years old by the time they reach patients. Is the latest iPhone a decade old?
FDA regulations may have been appropriate for their time, but they’re ill-equipped to address today’s speedy scientific advances. Instead of putting patients in randomized clinical trials designed before color televisions were widely available, why not let doctors prescribe the newest medicines in real-world settings? Combining “big data” and now-inexpensive computing to analyze treatments could cut drug evaluation times by years. The benefit to patients would be revolutionary.
Whatever the reshaping of Obamacare ends up looking like, it won’t be the conclusion of anything for patients – just the end of the beginning of what needs to come next. Health care reform as currently discussed won’t deliver its full promise unless it acknowledges there is an entire world of patients outside Washington who know better than the experts that access, innovation and regulatory reform impact their lives far more and every day.