01 Mar My View: Response to President Trump’s 5 Principles for Healthcare Reform
The president called on all Democrats and Republicans to work together on healthcare going forward.
Words have meaning, yes; and yet, the actions taken from here forward by both parties and in both the executive and legislative branch are what matter the most. Here are my own 5 principles that I challenge ALL who are in decision-making positions to keep in mind. Lives depend on it.
- Listen to real patients: Seek constituents in your communities if you don’t trust patient organizations (although you ought to partner with these noble and under-appreciated institutions). Spend time explaining your ideas, but also listen to what they are experiencing and their highest priority needs. Don’t dismiss the reality of their experience. These voices have value.
- Remember that there is NO SILVER BULLET: Rhetoric implies that any “replacement” has the “right” way to deliver care. There is no such one right way. Policy to support universal access to care should make use of every tool in the box to ensure Americans can access the right care at the right time. Nothing should be off the table, even if it’s not ideologically “your idea.” That’s true bipartisanship.
- Prioritize the most vulnerable. Those that can’t afford bus fare to their appointments, live with disabling chronic conditions or have already spent their life savings on care will have little use for HSAs or tax credits. The do need the earliest and most robust health care interventions to get well, stay well and thereby not become an unintended drain on already stressed health system resources. So flexibility for Medicaid is a good thing, but the end goal must be to ensure that no one gets left behind.
- Foster innovation from the front line. Stop pretending that Washington has all the answers and ignite creativity and solutions at the front line. Innovative health systems are already doing this and CMMI was created to foster this culture. It’s not perfect, but we need to expand that culture. Take ideas from direct care professionals and patients themselves, rather than PhD analysts or career legislative staff. Well-intentioned though they may be, you have a better chance of understanding the dynamics, barriers and potential solutions from ground zero.
- Be transparent about success AND failure. This is complicated (times 10) and you’re not fooling anyone with the bravado and promised sweeping reform plans. You won’t get it right this time (or next), just like the ACA. It isn’t perfect, but it achieved something no other plan has been able to: slashing the rate of uninsured Americans by historical numbers. That translates into millions of Americans being able to get actual care. So go forth and attempt to fix what’s broken, but be honest and transparent with Americans about what is working and what isn’t. Be willing to fail and adapt (it’s called governing). Trust and goodwill, and the willingness of all stakeholders to explore the necessary compromises will depend on how fast you learn to fail and pivot to capitalize on success.