As a divided nation heads into what promises to be the ugliest election in living memory, the nation’s healthcare establishment should brace itself for a tongue-lashing. If healthcare leaders think the rhetoric is misinformed, they should ask themselves the following questions.
If you’re a drug industry CEO, have drug prices come down? Are new drugs coming to market at affordable prices? Are generics reaching consumers shortly after patent expiration and at prices that are a small fraction of their brand-name predecessors? Are biosimilars making a dent in the exorbitantly high prices on specialty drugs?
If you’re a pharmacy benefit manager CEO, have you delivered on your sector’s promise of making drugs more affordable? Have you removed barriers to access such as high co-pays and deductibles that cause millions of people to either skimp or skip taking prescribed medicines, often at risk to their own lives?
If you’re a hospital CEO, have you lowered the cost of care? Have you reduced the price of hospital services that are readily available in nearby settings at a fraction the cost? Have you made prices transparent to your patients? Have you used mergers to improve care coordination, not eliminate competition and jack up prices? Have you eliminated balance billing?
If you’re a physician practice leader, have you eliminated the tests and procedures deemed wasteful? Have you expanded the role of physician extenders to make better use of high-cost doctors? Have you expanded primary care, and given those physicians adequate time to improve patients’ lives? Have you prohibited your physicians from taking emoluments from the drug and medical-device industries?
If you’re an insurance industry CEO, have you ensured your networks are adequate and your online rosters up to date? Have you adopted cost-control policies that don’t start and end with “just say no”? Are you aggressively managing high-cost patients with multiple chronic conditions and not just passing those costs on to your customers?
If you’re an appointed or career official at federal and state agencies, are you on a glide path to ending fee-for-service medicine? Have you required interoperability for diffused medical records, and made them portable and accessible to patients and payers? Have you reduced providers’ administrative burden by limiting the number of quality measures, and based them on outcomes, not processes? Are you expanding coverage and promoting access to affordable care?
If you’re in Congress, have you accomplished anything on any of the above? Have you put a dent in the opioid, mental health and obesity epidemics, or the underlying social causes of so much disease in our society?
If you’re in the White House or its administration, can you explain why the ranks of the uninsured have increased on your watch, despite near full employment? Can you point to a single health-related accomplishment or explain why you have contributed to ill health and the existential threat posed by man-made climate change through your aggressive deregulatory agenda?
Democrats campaigning for president and Congress like to say healthcare is the most important issue facing the American people. But when potential voters were asked an open-ended question in the most recent Gallup poll, fully one-third said “government/poor leadership” is their biggest concern, trailed distantly by immigration at 11%, healthcare at 6% and race relations, unifying the country and poverty at 5%.
There’s wisdom in those results. In a divided country, effective leadership capable of knitting together diverse coalitions is essential to solving festering problems. In its absence, self-interest, not the public interest, prevails.
So do politicians, especially the president, who spread ignorance and feast on divisiveness. If voters don’t opt for change next November, we will bequeath to future generations a sordid mess on multiple fronts, including healthcare.