Benchmark US health care!

Why are our US Congress Republicans, woefully incapable of understanding what ails healthcare in America, seem unable to articulate a plan, and worst, ignore benchmarking with other OECD countries that spend far less on health care with better outcomes (i.e. life expectency among others)? Even without taking sides here is what’s happening. 

It starts with Republicans that are deeply divided internally on healthcare policy, in spite of urgent deadlines. They just passed their GOP bill without extending Affordable Care Act subsidies, despite warnings that 22 millions will face steep premium hikes. In fact, Republicans are “torn over health care” and experiencing paralysis over which plan to support. In fact they can’t articulate a single, coherent plan. 

Many Republicans would like lower premiums, more choice and less government involvement, but the US system is built on massive federal subsidies, federal regulation, employer-based insurance, medicare and medicaid. So in the end, the GOP is caught between Ideology (smaller government) and Reality (millions rely on government-supported coverage) and that tension shows up clearly in the facts that moderates want to extend Obamacare subsidies, while leadership wants to avoid expanding federal spending. 

Further, for Congress, playing with healthcare is politically dangerous as every major reform creates winners and losers, cutting subsidies raises premiums, deregulating plans can reduce coverage and expanding government programs raises taxes. Even now, when Republicans controlled the House, Senate, and presidency, they still can’t agree on a replacement for the ACA (Obamacare)! I’ve always been of the opinion that the US should benchmark what’s done well by most OECD countries, but of course these nations have a single national payer system or tightly regulated nonprofit insurers. 

In contrast, the US has private insurers, Employer-based coverage, Medicare/Medicaid, VA, Obamacare, State-level rules, Federal rules, pharmacy benefit managers, hospital monopolies and drug manufacturers with global pricing power. So because of this fragmentation all these parties are threatened by benchmarking and the change it would entail. , commercialized, and politically entrenched. 

While Republicans lack consensus on the end goal, Democrats generally agree on universal coverage, government playing a strong role and benchmarking against OECD systems. Bottom line: If we want to change the US healthcare system we need to push the Republican in the minority, it’s a simple of that!