American healthcare at the crossroads

So now we have health plan proposals from both Republican controlled houses of Congress. Let’s strip away for a moment the mountain of detail that defines these proposals and drill down to the core message; the federal government has no business ensuring that all its citizens have access to affordable, quality healthcare.

The Democratic position is exactly the opposite, the federal government must work to ensure quality and affordable healthcare for all. This is an ideologic clash no less monumental than that which occurred over slavery in the mid 19th Century and its role in American Society.

Are we to evolve into a society where the “Survival of the Fittest” is our credo? Where, to quote Ebenezer Scrooge in “A Christmas Carol” when speaking of the poor houses, “Those who are badly off must go there.” When those around him respond “many can’t go there; many would rather die.” He replies,”If they would rather die they had better do it and decrease the surplus population.”

Thirty-one states are in a budgetary deficit situation, 31 states. Are we as a nation of states so willing to delude ourselves to think that these states, and others, are in any position to assume from the federal government the independent provision of healthcare services for their most vulnerable citizens? Not a chance.

Back to the days we will go where millions of uninsured will use the healthcare destination of last resort, the emergency rooms, where they are required by law to be seen. Care again will become fragmented, too late for many where the damage has been done, excessive and inappropriate as defensive medicine is once again rampant to avoid risk of accusations of malpractice. Should we then remove the law that requires emergency rooms to treat all who show up on their doorstep? What then?

Isn’t our greatest national asset our citizens, young and old, rich and poor, all ethnicities and cultures? We need to strengthen our primary care and public health resources, not weaken, dismantle and ultimately overwhelm them.

Published this week in the New England Journal of Medicine is a “Sounding Board” article that concludes the following,

“The body of evidence summarized here indicates that coverage expansions significantly increase patients’ access to care and use of preventive care, primary care, chronic illness treatment, medications, and surgery. These increases appear to produce significant, multifaceted, and nuanced benefits to health. Some benefits may manifest in earlier detection of disease, some in better medication adherence and management of chronic conditions, and some in the psychological well-being born of knowing one can afford care when one gets sick. Such modest but cumulative changes — which one of us has called “the heroism of incremental care” — may not occur for everyone and may not happen quickly. But the evidence suggests that they do occur, and that some of these changes will ultimately help tens of thousands of people live longer lives. Conversely, the data suggest that policies that reduce coverage will produce significant harms to health, particularly among people with lower incomes and chronic conditions.”

Commonly quoted is “A rising tide lifts all boats.”That is no less true for healthcare. DO NOT turn back the clock to an earlier, increasingly unaffordable and dysfunctional profit driven industry.

DO NOT favor the “haves” over the “have nots.” Push forward to keep what works in Obamacare and change what has not. Recognize the “Triple Aim” imperative of  improving the health of our population for e-v-e-r-y-o-n-e, improving the patient experience of care (quality and satisfaction) and improving the cost of care-deliver the best value.

H. Andrew Selinger MD, is Chairman of the Department of Family Medicine at the Frank H. Netter MD School of Medicine at Quinnipiac University