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Friday, July 22, 2016

US Health Care Reform: Progress and Next Steps

Article by Barak Obama, JD just published in the Journal of the American Medical Association (JAMA). I'm not certain how to concisely respond to this data nor to the structure and strategies of RomneyCare (2006) and ObamaCare (2010). I feel that a long form response is needed, but I'm fairly confident that if I do that almost no one would read it anyway. In short, I do have strong buy-in to the objectives of RomeyCare and ObamaCare of increasing access to and quality of health care in America while limiting costs, but I do not have strong buy-in to the strategies. I am conflicted in this because I see both programs as predictable outcomes of the current health care financial incentive structure and that the current system does not permit the solutions we truly need. What we truly need is health care financial reform with true fee-for-service with national health savings account (HSA) for all taxpayer households and a safety net system for non-taxpayers. Being upset with RomneyCare or ObamaCare is analogous to going to Cuba and being upset that they are driving cars 50 years old which can only be kept going by bandaid solutions. The frustration is misplaced as the underlying system dictates the options. In terms of health care in America, the underlying dysfunctional financial incentive system dictated the options of RomneyCare and ObamaCare. For Cuba to have modern cars and to be free from bandaid repair solutions, the system which prevents there being modern cars on the roads has to change. Likewise, for American health care, the existing health care finance incentive system needs to change in order to permit different solutions. RomneyCare and ObamaCare are simply bandaid solutions and not true health care reform. As pop-star Taylor Swift sings, "Bandaids don't fix bullet holes."1 There is no health care reform without health care financial reform. 1Swift, Taylor. Band-aids don't fix bullet holes. "Bad Blood". 1989. mp3. Big Machine Records. 2014.
from Rajesh Harrykissoon, MD

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