You learn a lot about our great country and the citizens who inhabit it when you move from Beverly Hills to rural Pennsylvania. The good people here face a weak economic engine and little opportunity for a sustainable living wage. In the central region I now call home, proud farmers who once fed the nation are struggling to keep afloat businesses that have been in the family for multiple generations. Too many of my new neighbors lack reliable access to affordable, nutritious foods.
Yes, there are two Americas and nowhere was this more evident than this past presidential election. But as one great country, together, we need to make America healthy again.
As the president and chief executive officer of a growing health system, I’ve been inundated with questions and concerns from colleagues, reporters and even family members regarding the repeal of the Affordable Care Act. Since the morning of Nov. 9, a sky-is-falling sentiment has begun snowballing in recent days amidst the professional and personal circles I navigate.
I say we need to step back and take a few deep breaths before we lament the so-called health care apocalypse. Let’s face it: The United States health care system was a mess long before the implementation of the ACA. Yes, Obamacare insured millions of previously uninsurable Americans yet insurance premiums continued to rise. U.S. health care costs were and are still the highest per capita in the developed world. Our health outcomes were abysmal. Insurance companies began narrowing networks and physicians started refusing health insurance altogether because they couldn’t deal with the paperwork. We were spending way too much for what we were getting in return.
We still are.
If the ACA is repealed and replaced, the world will not implode. True health care reform began way before Obamacare became law. We started seeing market consolidations and shifts from being paid on the volume of services we provided to the value of those services. Bundled payments for episodes of illness and procedures began replacing fee-for-service models responsible for driving increasing costs. We and other likeminded health systems around the country committed to higher quality, lower costs and population health efforts aimed at keeping our patients healthy and out of our hospitals. We saw the value in delivering value to our patients — superior outcomes and unsurpassed patient experience delivered at a lower cost.
A change in the White House should not affect these goals.
President Trump is a businessman. Good business means good value. And with a Republican government in place, we most likely will see a lessening of some of the regulations under the former model that I don’t think make sense anymore. Health care may become more market-place driven.
And even if Americans lose insurance coverage — which I certainly hope doesn’t happen — this drive to value still makes sense. Before the ACA, uninsured patients flooded our emergency rooms with non-urgent conditions. We took care of them in our expensive ERs because we were unable to connect them with ongoing primary care. Those costs were then shifted to our insured patients. It is cheaper and certainly more humane to provide that care outside of the ERs in primary care offices. So, for a system like us, if we are faced with thousands of uninsured friends and neighbors, again our primary care team is better equipped to care for them and at a lower cost than our ERs.
Regardless of socio-economic or political differences, cancer strikes in Bel Air, California, the same way it does in Shamokin, Pennsylvania. Depression hurts the same way in Century City, California, as it does in Atlantic City, New Jersey. The presidential transition is over. We the doctors, nurses, support staff, the communities we live in and the patients we serve need to fix the health care system from the inside. It won’t happen in Washington.
Many great American innovations have started in cities and towns where people came together. Healthy communities are key. We need to address and improve the social determinants of health. We need to take better care of ourselves. Healthy habits are hard to acquire but if we all got there we would cut our health care costs in half. Access to care, including substance abuse and mental health treatment, need to be readily accessible. Today, genomics allows us to predict and prevent illnesses altogether.
We have no excuses. This is a moral imperative to ourselves, our families, our communities and our country to improve our health and our health care system. Without a crystal ball, it is hard to know the future of the ACA and what will replace it. I am not a political pundit. I am a healer. And there is much work we healers need to focus on today.
David T. Feinberg, M.D., MBA, is president and CEO of Geisinger Health System.
