Tom Price, MD, former HHS secretary, identifies key principles to keep in mind as the political parties move forward with any health policy changes.
One of the biggest challenges facing the healthcare system in the United States is that there isn’t just one system, according to Tom Price, MD, former HHS secretary. There are multiple healthcare systems and they are in their own silos.
There is Medicare, Medicaid, employer-sponsored insurance, the exchange system through the Affordable Care Act (ACA), the Veterans Health Administration, and the Indian Health Service, he explained during his keynote speech at the 15th Annual World Health Care Congress. And each system has its own set of rules for financing and delivery.
“So, it’s a hodge podge of systems and we, somehow, expect that people will somehow be able to move seamlessly from one to the other,” Price said.
Even though there are silos in healthcare due to multiple systems, there is a huge opportunity to harmonize, in a voluntary way, much of the systems, he said. Doing so would result in greater efficiencies and a better experience for patients.
However, when the government acts in healthcare, “it tends to act slowly or clunkily or inefficiently,” Price said. While discussing government involvement in healthcare when it comes to the ACA, he called the failure to pass legislation in 2017 to repeal and replace the health law “the height of political frustration.”
He believes that without the individual mandate and Medicaid expansion, there was a lot of common ground between the 2 parties. Everyone wanted a system that is accessible and affordable and provides high-quality care, but those 2 provisions of the ACA caused a sharp divide among the parties, he explained.
But, Price noted, right now it looks like the ACA market has stabilized. The patients on the exchange plans tend to be sicker and more expensive, and he wondered if the ACA market as a whole should be treated like a high-risk pool.
“Are these exchanges the de facto high-risk pools that many people talked about being necessary [but] without the efficiency or true planning of a high-risk pool?” he asked.
Like CMS Administrator Seema Verma, who took the stage the day before, Price touched upon state flexibility, as well. If Washington, DC, cannot solve the issues at hand, then state flexibility might be the next path, he said. And that flexibility goes in both directions, he noted.
In addition to Kentucky, Indiana, and Arkansas having waivers to add work requirements to Medicaid approved, New York is weighing a bill to institute a state individual mandate, Minnesota is looking at a reinsurance bill, and California is considering a state single-payer system.
“That kind of flexibility may be the wisest way to proceed from a public policy standpoint—to allow states the opportunity to figure out what works best for their citizens,” Price said.
On the path forward, it’s important that the principles of affordability, accessibility, quality, responsiveness, innovation, and choice are kept in mind as the political parties try to find common ground in health policy.
However, he admitted that the task ahead is daunting, and history has shown it will not be easy to get anything done.
“I would suggest to you that options and choices and a voluntary nature to change, those are the lynchpins to moving forward in a positive way,” Price said.