Unlike other industrialized nations, the U.S. health care system doesn’t prioritize comprehensive primary care. Health care is uncoordinated and fragmented and emphasizes intervention rather than prevention and comprehensive health management
Every American should have access to meaningful, affordable health care coverage - but it should not be required. We also need to build on our current system of coverage provided by employers, government, and individually selected plans so that patients can benefit from choice and competition. This fits with our long-standing policies of pluralism, freedom of both choice and practice, and universal access for patients.
Preserving the ability of patients to choose the health plan that best fits their needs must be a priority. Also, retaining variety in the potential payer mix for providers while reforming payment and delivery processes is an essential element in fully covering the costs of care and ensuring practice sustainability.
A single-payer option is not a viable solution, because it is a one-size-fits-all approach that would ultimately reduce coverage options and eliminate patients’ freedom of choice. It also would destabilize coverage for some 150 million people with insurance, which accounts for about 20 percent of the U.S. economy.
In determining the best way forward for the world’s largest health care system, we should recall the ethical imperative to “first, do no harm.” Fixing the imperfections of the ACA will focus primarily on extending coverage to the uninsured, not dismantling the existing coverage most Americans enjoy today.
Ideas to improve the ACA and other updates to medical care:
- Expand eligibility for tax credit offsets of premiums to five times the federal poverty level.
- Provide enhanced tax credit offsets to young adults while retaining the ACA’s current formula, which is inversely related to income.
- Fix the “family glitch” while lowering the threshold that determines whether an employee’s premium cost is “affordable,” which affects subsidies to buy coverage on health insurance exchanges.
- Support efforts at the state level to expand Medicaid eligibility to 133 percent of the federal poverty level
- Health insurance plans should allow primary care visits without a deductible or at least a limited number without a deductible. Primary care should be considered more like a utility than a service.
- Some rural communities have a higher maternal mortality rate than those of Third World countries, yet they are continuing to close hospitals. Health care leaders must invest in the health care of rural communities and provide cost-effective access.
- Health care leaders can improve access and reduce costs by investing in and utilizing telemedicine, artificial intelligence (AI), and electronic health records (EHR).
- Telemedicine is not just a tool for patients — in fact, research has shown that patient usage doesn’t reduce cost. The real power (and cost savings) comes when it is utilized by the primary care doctor in partnership with the patient to access specialists. For example, telemedicine can be used in rural hospitals to provide access to specialty care, like oncology, enabling the primary care provider to deliver the necessary treatment in their own office with the guidance of the oncologist.