June 19, 2018
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Supreme irrelevance?

Erik Steele
By Dr. Erik Steele

Someday soon the U.S. Supreme Court will decide the constitutionality of President Obama’s Patient Protection and Affordable Care Act. Those who think the court’s decision will close the barn door on the horse of health care reform should not cheer or despair; that horse is long gone. In fact, the whole darn herd of health care change has escaped and is now stampeding across the American health care countryside.

There will be no corralling that thundering herd. Raised on a steady diet of chaotic and inadequate health care, whipped into a state of desperation by ruinous health care costs and run to an exhausted lather by decades of failure of our leaders to fix these problems, the herd is now dubious about the benefits of that old barn.

One such horse is the patient as a new health services shopper. More than 140 million Americans who are self-employed or have employer-based health insurance now pay thousands of dollars each year directly out of pocket for health care, on top of their insurance premiums. They are learning that one can shop for some health care and thereby substantially cut those expenses. This is a rapidly developing and huge potential market force being applied to the simple and ruinous fact our health care has not been a price-sensitive service.

Nothing the Supreme Court decides this month will stop what this new market force will probably produce in the next few years — a race to the lowest price possible for some nonemergent health care services. These will include colonoscopies, MRI and CAT scans and many surgical procedures. Large profits on these procedures will disappear in many markets, saving consumers billions of dollars and threatening the existence of some hospitals that depend on profits in those areas to keep them afloat.

Health care of marginal value will be another target — the millions of tests, procedures and other treatments we get and pay for that do us little real good. For the first time ever this is coming under the concerted gaze of patients, families, employers, insurers, media and politicians. Most importantly, many physicians and health care organizations are now finally trying to lead the herd in an effort to trample wasteful care into the mud. Nine smart people in black robes can say anything they want about what is and is not constitutional in health care reform, but waste in health care is in for a sustained stomping, regardless of what they say.

Nor will smart health care organizations and physician groups change their new directions if the Supreme Court tosses the Obama-Romney health plan (Obama’s plan was largely modeled on Romney’s plan for Massachusetts) back to a yapping, tail-chasing US Congress. Those organizations are hell-bent on reducing the costs of their care because they know, no matter what happens in Washington, America is going to be spending less money on health care.

Many of those forward-looking organizations are figuring out how they can sell not just health care, but also the ability to manage health and health care costs. Those with enough patients and money may get into the business of insuring patients, not just taking care of patients, as the Kaiser Permanente health system has done. Forward-looking insurance companies are doing just the opposite; buying physician groups and getting into the business of taking care of patients, not just insuring patients. This turning of parts of the health care system on its head will not stop even if the court overturns the health reform law.

None of this means the Obama model for health reform is irrelevant; it’s the only real plan advanced in two decades to ultimately get every American insured. Strangely, it may be the last best chance for anything other than a single-payer, government-funded plan; if enough Americans lose their insurance over the next five years, frustrated voters may just demand Medicare for everyone, a simple, single-payer solution that may look more appealing as alternative options dry up.

If the Supreme Court tosses out the Patient Protection and Affordable Care Act, runaway horses will be running roughshod over many parts of our health care system. Some of that will be very painful.

Erik Steele, a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.

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