posted by AHIP
on September 12, 2019
On The Next Big Thing in Health, AHIP’s President and CEO Matt Eyles discussed the challenges faced by the health care industry today, the ineffectiveness government-run health care proposals, how the private sector can help us achieve universal coverage, addressing social determinants of health, and more.
Matt Eyles: Just given where we are relative to very big elections coming up in 2020, I think this is a very important formative year with respect to health reform, looking ahead to 2020, 2021. As we contemplate what that path might look like, I think there are four main elements to it.
The first is really, we need to find a way to cover everyone. We still have 30 million Americans, roughly, who lack health insurance. So, we need to find a path forward to cover all of those individuals because every American should have access to comprehensive medical coverage.
The second piece is around affordability. Our system is too expensive. I think we’re at a tipping point for patients and consumers, and businesses and government with respect to what we can afford. We really need to find ways to make our system more affordable at a systemic level. But, also at a personal, individual level.
The third piece is with respect to patient-centered care. How do we make our health care system more personal? More accessible? More understandable? Empower consumers to really have the information that they need to make the decisions, with their physicians and providers that are best for them. In a way that makes the most sense, given their own personal circumstances.
And the final piece is really how do we reduce the underlying cost of care? Whether it’s prescription drug prices, how much we are paying for hospitals. All of these inputs are really why we see premiums where they are and cost sharing where they are. How do we advance value-based care? It’s really about reducing the underlying cost of care.
The final point I’ll make is that it needs to be done in an environment that promotes private sector innovation. We really think, very strongly, that the private sector is the best way to do this. That’s not to say that there’s not a critical role for government, but that government is not going to be the solution to those challenges.
Matt Eyles: With all of the people that we’ve talked to, what’s really motivating this are two factors. First is the affordability of our health care system. There’s a feeling that Medicare for All will make things more affordable. There’s good information and data out there that show that that’s probably not the case. But it sounds like it could be, which is one of the attractions.
The other thing is around simplicity of the health care system – the lack of simplicity and how complex it is. Again, Medicare for all sounds very simple. People like Medicare, why don’t we just expand that program? How you actually do that and execute that is enormously complex. And will not ultimately solve the problems we want to address in the four areas that I talked about before and would take us in the wrong direction. It would lead to longer wait times, worse health outcomes, higher taxes, more spending.
We really need to fix and improve what we have built, expanding upon the affordable care act. Rather than trying to blow out the entire system.
Matt Eyles: We’ve touched on a couple of them already, certainly with respect to the underlying cost of care. I mean that really is driving so much of the problem, the price of prescription drugs. And, I say this with great respect for an industry that develops cures. But, the economics of that equation have really gotten out of whack in the last decade since I worked in the industry.
When you see the price of some of these new products and innovative, important therapies – six, seven figures now. It really begs the question of how we can sustain that and what kind of affordability we will see if you’re going to have products cost that much.
We also need to advance interoperability within our health care system. That’s a critical gap. And how we can leverage the technology that we have, get it to work more effectively, the way that we see it work in other parts of our lives. But that is falling short in health care
The question is how quickly can we actually do it? We’re a little concerned if you try and do it too quickly, given where we are today, is it actually going to backfire in some certain ways? Those are a couple of the biggest problems that we see, and why we are focused on making sure that the solutions come both from the private [and public] sector in terms of how we address them. But that there also needs to be, again, a policy component to doing it because not all of them can be solved just by saying you need to innovate better or do this faster.
Matt Eyles: There’s been so much attention paid to it – so-called “social determinants of health.” What are those social factors that influence health? It could be about transportation, nutrition, access to health care, where you live, educational background, income.
All of these factors have important impacts on health. And, were only really beginning to understand how important they are and trying to connect them to the health care system. Our members and the entire health care ecosystem is really focused on how can we improve addressing social determinants of health?
It’s one of the reasons why we launched a new initiative called Project Link at our AHIP Institute conference in June. Because we believe that it’s important to allow our members and other partners to really learn what’s working. How do we share best practices? How do we test what’s working? What’s not working?