This week, healthcare has been center stage in the first 2 democrat debates. While the debates certainly talked about a wide range of issues, healthcare was a major topic in both nights of the debates. In case you missed them or can’t stand to watch them, go over and read through the healthcare debate summaries that Jane Sarasohn-Kahn published on her Health Populi blog: Healthcare – Night 1 and Healthcare – Night 2.
While the debates are interesting fodder for the candidates perspectives on healthcare, we should first acknowledge that this debate format is going to do little to actually solve, understand, or even cover the absurdly complex healthcare challenges. So, I think we should be careful trying to hold these candidates accountable for their perspectives on healthcare in this soundbite driven format. To really improve healthcare it takes a lot more than soundbites.
That part aside, thinking about these debates, I had one over-arching thought going through my head:
When Have Politicians Ever Agreed on What to Do to Fix Healthcare?
Like it or not, government is the largest healthcare customer and much of the healthcare system queues up what they do based on government actions. And in the US, very little change can happen when there’s not agreement or consensus. That’s the good and the bad of the US government. Even when people agree it can be hard to get it done, but I’ll leave that discussion for another day.
I first saw this principle in all it’s glory when I heard John Boehner, Former Speaker of the House, speak at a health IT conference. It was shortly after the Republicans had done well in an election. As part of the election process, many republicans touted the phrase “repeal and replace” of Obamacare as their healthcare strategy.
In his talk, John Boehner talked about this idea and then commented how he never understood how Repeal and Replace was possible because Republicans had never agreed on what to do with healthcare. There was some consensus on repeal, but Republicans were never aligned on what the “replacement” would be. If you don’t agree on the replacement, then it’s hard to get legislation passed and sure enough, the repeal and replace legislation never passed.
You’ll notice that in this article I haven’t addressed whether repeal and replace, Obamacare, Medicare for All, etc are good policy choices. I’ll leave those topics for other blogs or at least other blog posts.
My point here is not a partisan discussion since it applies to both sides. Just like the Republicans weren’t aligned on what a replacement to Obamacare would look like, the Democrats are not aligned on what they want to get accomplished in healthcare either. These debates highlighted this really well. Even the Medicare for All idea which many Democrats have gotten behind is a challenge since there are a few hundred definitions about what Medicare for All really means.
There’s very little political alignment on this issue and that’s true for Republicans and Democrats. Plus, there are a lot of constituents back home that have a familial vested interest in what happens to any changes to healthcare. Everyone has someone they love who is sick, who works in healthcare, or is in some way connected to healthcare and will be impacted by the changes.
This is a big reason why healthcare policy is so hard. There are a lot of people feeding at the healthcare trough. In fact, it’s probably more apt described as a lot of people feeding from a bunch of healthcare troughs. We all know that we’re spending too much on healthcare, but we the politicians in Washington can’t agree on which troughs to tip over.
What does this all mean for healthcare IT? From my perspective, we’re going to hear a lot about healthcare this political season. It’s going to get ugly and nasty. However, I don’t believe all that talk is going to have much of an impact on healthcare IT. All the drastic things they’re talking about are just talk that I can’t ever seeing pass through the political process.
What’s your take on all this? Are there things I’m missing that you think people should be aware of? Do you have a differing prediction on how the upcoming elections are going to impact healthcare? I’d love to hear your thoughts in the comments or on Twitter with @HealthcareScene.