Before I begin the latest entry in my healthcare diary, I want to thank AdamB for his support and his recent write-up about me. It means a lot to me have strong, progressive leaders like Adam on my side.
Now onto healthcare. We all are very happy that Congress finally showed some courage and passed a bill that makes improvements on the current healthcare system. I believe this passage has the potential to be viewed as a historic moment in healthcare policy, but only if this bill represents the beginning of healthcare reform efforts, not the end. I supported the bill that the President signed on Tuesday, but I believe it is far from perfect, and I think we need to do a lot more to truly have high quality, affordable healthcare for all.
One of the biggest missing elements in this bill is a medical cost-control mechanism. Rapidly rising costs are the crux of the healthcare crisis and if we do not do something to significantly curb the pace of annual healthcare costs increases, it will be very difficult to maintain the coverage that we want. The only way I see to do this in the short-term is by offering all Americans a robust, Medicare-like alternative to private insurance (some would call this a public option, but I hate that term, I’d rather call it a Medicare buy-in or, if you want to take a page out of the Republican playbook, lets call it the "Freedom Plan"). This alternative would hold the insurance companies feet to the fire and force them to offer an efficient, quality product at a reasonable price. In the long-term, to truly get at the heart of the healthcare cost issue, we need to better figure out what works and what doesn’t work in medicine. The dirty secret in healthcare is that 30% of everything a doctor or a hospital does, makes no difference at all in your health outcome. Yet, right now, we don’t where that 30% is. To figure that out we need a much greater investment in comparative effectiveness research and a better way of disseminating and rewarding best practices. Lastly, two of the big drivers of healthcare costs are chronic diseases and care provided at the end-of-life. Efforts must be made at figuring out the disease management models that truly bring down costs and improve quality and, without re-igniting the ridiculous death panel discussions; doctors, patients and families must all have a frank and earnest talk about end-of-life care before it is too late to have that discussion.
Besides costs, I also would like to see the built environment and the overall social determinants of healthcare addressed in a more meaningful fashion. Nearly 80% of your healthcare is determined by what you do outside the doctor’s office or the hospital. Its what we eat everyday, the exercise we get, the air we breathe, and the access we have to healthy foods, walking paths, etc. that determines the bulk of our health. An investment in assuring that all children have access to fresh fruits and vegetables, safe and accessible playgrounds and an education on healthful eating would be strong start in battling the childhood obesity epidemic. And, this goes for adults as well. If everyone walked a little more and ate a little healthier, our bodies and our healthcare system would be in much better shape. The government doesn’t have to be the one to mandate this, but we can facilitate and incentivize these behaviors.
Don’t get me wrong, I am elated that we finally passed something on healthcare. But just as I want all Americans to walk more, I want our Congress to continue to take steps in the right direction to truly get the best healthcare system that we all deserve.
Typically I take health related questions when I post here, but tonight I am going to just read your thoughts and listen to what you have to say.
Manan Trivedi is a candidate for congress in the PA-06, a primary care physician and an Iraq War veteran.
