Can states actually reform the healthcare market?
Although Republicans have scrapped their latest health reform effort for now, the debate continues to rage on. The goal seems to be achieving insurance premium and marketplace reform, but there is still very little debate regarding addressing the actual cost drivers in the healthcare system.
The Graham-Cassidy bill pulled Tuesday by Sen. Majority Leader Mitch McConnell (R-Ky.) would have sent block grants to the states with the intention of having states deliver insurance marketplace reform at a local level. The principle at work here is that those closest to the marketplace are in a better position to deliver ideas and solutions.
This is an interesting concept — except for the fact that the states are not set up to deliver insurance marketplace reform or address long-term cost drivers, such as hospital capacity, the overabundance of technology in the healthcare system and the cost of pharmaceuticals. Industry lobbying groups, insurance companies and pharmaceutical companies are too well organized and too well invested compared to the voice of the consumer or patient. The latter, unorganized parties, lack advocates in the legislatures.
If the Trump administration is able to pass future legislation giving states block grants, it will be interesting to see how many innovative solutions will be developed at a state or local level and if key stakeholders in the healthcare delivery system will act as participants or obstructionists.
Path to single payer?
Meanwhile, while Washington hopes to provide monies to the states to develop innovative solutions to reform the insurance marketplace, there remains little-to-no discussion on how to truly reform not only the insurance marketplace, but also reform the healthcare delivery system.
As the can is continually kicked down the road, the legislatures at the federal and state levels march slowly toward a single payer solution. As a Canadian, I know first-hand the positives and challenges that exist within a single payer system. It brings to mind the old saying, “Be careful what you wish for.”