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America and healthcare: A complicated affair

Pretty much everyone on ‘the Hill’ in D.C. agrees that reform of the American health system is badly needed, but that’s where the consensus ends. Healthcare has become the most partisan wedge issue in 21st century American politics, having already left an indelible mark on President Trump’s first 100 days in office.

Seven years and dozens of abolition votes, all predestined to be vetoed by the then President, stoked Republican opposition to Obama’s Affordable Care Act. ‘Replace and repeal’ became a rallying cry on the GOP presidential campaign trail but there was no agreement whether it would be undertaken in one fell swoop or as two separate actions.

The American Health Care Act’s failure to reach a vote was due to an unholy alliance of conservative Republicans (who objected to what they called ‘Obamacare Lite’) and Democrats, who decried the 24 million Americans estimated to lose their health insurance coverage under the new legislation.

Amendments to the AHCA are in the news daily but seem as far away from ‘majority support’ as ever. It’s a situation aptly summed up by a tweet from Michigan GOP congressman Justin Amash, “’Binary choice’ fallacy is a tool partisans on both sides use to quash policy debate and avoid (the) difficult job of persuading and legislating.” When healthcare reform is predicated largely upon winning over voting bloc intentions, bad legislation will likely follow.

It’s clear the data demonstrates that despite the United States having the most expensive healthcare in the world, it does not result in the best health outcomes, so something is clearly amiss.

Under the ACA fee-for-service payments are beginning to give way to pay-for-value, which rewards care providers for improving patient health outcomes. Many advocate for these payment changes to be accelerated, necessitating a dramatic change in operational and management systems.

The danger is that whatever legislation emerges in the weeks and months ahead will, in time, itself be undone by a future administration. The benefits of disruption must always exceed the cost of change, which, in the healthcare sector, falls upon providers, payers and, ultimately, the consumer. Only time will tell if the ‘binary choice’ currently in front of legislators will provide the healthcare the American public deserves or whether a truly bipartisan option will emerge.

Tim Exton is a healthcare aficionado and a freelance journalist based in Seattle. He has reported on a wide variety of topics for international news agencies and organizations including Reuters, Agence France Presse, Seattle Times, The Guardian, and NBCNews.com. Tim is a personable Englishman who loves hearing from his readers, so feel free to contact him at healthcare@sutherlandglobal.com.