Newtown, CT- November 19, 2016
Three Thanksgivings ago, as insurance exchanges across the country started to function the way they should, hundreds of thousands of individuals could finally be thankful they had access to health insurance – What had and has been taken for granted in every other developed nation – access to health insurance – was now available to Americans across the country. At the time I wrote that the mission to make this change permanent lied in our hands, and our failure to turn the delivery system into a high value sector of the economy (as opposed to the drain it was and still is today) would mean an inevitable return to bleak prospects for millions of US residents. While the demise of many exchanges is also due to factors other than the failure to turn the delivery system into a high value sector of the economy, we shouldn’t underestimate its impact. Prices have risen a lot, quality hasn’t improved significantly, and transparency is still anemic. The market for health care still doesn’t work.
What this means to you – We have to get this right and can’t stop until we do. There’s no doubt left that many providers, even if not the huge majority, understand the essential importance to transform, thanks to the unwavering push towards value-based payments implemented by Medicare, Medicaid and many private sector payers. But still way too many of those private sector payers are sitting on the sidelines. They don’t seem to care that exchanges fail or succeed. They don’t seem to care that the price increases they’re negotiating with providers are choking employers and employees, let alone those who shop on the exchanges. And they don’t seem to care that the rate of poor quality is also sky high. If they did, the volume of value-based payments would be significantly higher than it is today. The pressure on providers to dramatically improve the quality and affordability of health care would be as crushing as premiums are to ordinary families. And we would see vibrant competition at all levels of the system. So as we gather for this Thanksgiving, we should still be thankful that many more Americans have access to health insurance than they did four or five years ago, but there is even greater urgency to drive value into the system. Because if we don’t act it very well may be the last Thanksgiving for a basic social right.