THE PETRIE-FLOM CENTER FOR HEALTH LAW POLICY, BIOTECHNOLOGY, AND BIOETHICS AT HARVARD LAW SCHOOL | Fifth Annual “Health Law Year in P/Review”
Cambridge, MA – January 23, 2017
My name is Mendel Groden, and I am a second year medical student at the Albert Einstein College of Medicine in New York City. I only became interested in health policy after I started medical school, when I realized how much our patients are affected by healthcare policy. I found myself being exposed to a one-sided viewpoint as to effective policy at school and decided to start researching on my own. When I was told about the conference at Harvard Law, I thought it would be a great opportunity to hear from experts on healthcare policy themselves.
The first panel discussed what healthcare reform is likely to occur under the Trump administration. Panelists included Joseph Antos, PhD, MA of the American Enterprise Institute; David Blumenthal, MD, president of the Commonwealth Fund; Michael Gusmano, PhD, of the Hastings Center; John McDonough, DrPH, MPA, professor of public health practice at the Harvard School of Public Health; and, Abigail Moncrieff, JD, associate professor of law at Boston University School of Law. While viewpoints and predictions ran the gamut from extremely optimistic to equally pessimistic, the entire presentation unintentionally served to show the problem with current healthcare dialogue itself.
Given a panel of this caliber of expertise, following the conversation required understanding subtleties and complexities inherent in healthcare insurance systems, as well as how state governments and the federal government function, and how the three interact. I find it telling that despite the numerous speakers each with a different professional background, the conversation centered on health insurance instead of access to healthcare. It seems that much of the public equates having health insurance with having access to healthcare. This may be true for now, but it certainly does not equate to having access to care sick people actually need. It is also apparent that people find health insurance so critical because health care costs have risen so drastically. Specifically, Abigail Moncrieff mentioned that, whatever happens moving forward, Obamacare has anchored what is acceptable as policy in the public’s eye, quoting that even President Trump has said everybody will have insurance. She further claimed that more people having access to health insurance is a goal everyone should strive for.
The debate between proponents of government-run healthcare and those of market-influenced healthcare is often framed as a moral issue. Proponents of more government intervention argue that unlike cell phones, healthcare is not a commodity that should be available only to the highest bidder. The healthcare system of a country as advanced as the United States should therefore be one based on compassion and not profit. These advocates see themselves as moral crusaders fighting for the common man and demonize those who support market influences as greedy profit mongers. This is a false dichotomy.
The first question that must be analyzed is: How did we get to where we are today? We currently find ourselves in a situation where access to healthcare is largely limited to access to health insurance, and access to health insurance is based on one’s ability to pay, and it is becoming increasingly more expensive. Why? Why are prices so high? Why do they keep rising?
Those who support more government interventions in our healthcare system like to say that the market system, which we had prior to the ACA, is at fault for all our healthcare woes. They fail to note that the system we had before the ACA was not a free market system at all. For years, we have had a highly regulated system with no transparency with regards to billing and services provided. Nobody who sees a doctor knows what they are paying for; they just know it’s expensive. With cell phones on the other hand, people know exactly what they are paying for. Is it so outlandish to suggest this may be just one of the reasons almost everyone can now afford a smartphone or laptop but not decent and cheap healthcare—and further that the ACA has only strengthened those regulations? Costs aren’t going down, prices are still going up, yet the panel seemed to be primarily interested in a post-hoc discussion of what is going to happen with our still flailing system.
To be fair, the conference was titled “…Health Law Year in P/Review.” Given our lack of market influence in healthcare prior to the ACA, and even less of it now, a review of the past year and a preview of the current year should not involve a discussion of the actual root causes of our healthcare system’s issues. Sarcasm aside, these are issues that people must begin having serious discussions about. Rather than accepting the status quo and searching only for top down approaches to regulating healthcare, a critical analysis as to the cause of rising prices and lack of access should be undertaken, after which thoughtful policies aimed at mitigating costs could actually be implemented. We need people to have access to care, not insurance. Perhaps Abigail Moncrieff was correct in asserting that Obamacare has anchored what is acceptable as policy, and perhaps this itself is the problem.