The Balancing Act of Cost vs Access to Care

John Fox, MD: What’s interesting is that there are several ways of controlling healthcare costs. One is by controlling the cost of the services that are provided. The other is just preventing people from getting access to those services. I think we have a debate right now where we have to answer that question. As a just and caring society, are we going to provide access to everyone or are we going to say that the only way to limit healthcare costs is to prevent some people from having access to it?

Elizabeth Carpenter: I don’t think members of Congress are having this philosophical debate right now—just to throw that out there.

John Fox, MD: What do you think they’re talking about?

Elizabeth Carpenter: I think they’re talking about the fact that they promised to repeal and replace the Affordable Care Act, and it’s been a campaign issue for 6 years. Now, they’re in charge, and it’s time to deliver. And it’s proving a challenge because—as our president pointed out—healthcare is complicated and personal, as you are all articulating right now.

Robert Carlson, MD: I think all of us at this table have known that healthcare is really complicated for a long time. I would hope that our legislative representatives understand that they have a responsibility to their constituents, both those who voted for them and those who didn’t, and that it’s really about the contract they should have with our citizenry—with all Americans. Americans should not die because they don’t have access to the basics of healthcare. And I don’t think we’re even talking about what I would call premium healthcare—just the basics of healthcare.

Elizabeth Carpenter: And one of the things that I certainly think gets delivered to cancer patients under the Affordable Care Act is the required maximum out-of-pocket limit. That’s something for in-network covered services that applies not just in the markets that we talk about—in the individual market—but also in the commercial market. More than 10% of employer plans prior to the ACA didn’t have a maximum out-of-pocket limit, which obviously makes care in these instances unaffordable for individuals and they have to choose between other necessities and their health. And I think that is a balance Washington continues to face.

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