Policy, Payers

Stop talking about ‘quality’ healthcare if you don’t deliver it

Having insurance only means that someone else will pick up part of the tab, not that the care would be of high quality. And the U.S. certainly has had nothing close to the greatest healthcare in the world, just the most expensive.

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Not this again.

In the fractious debate prior to the passage of the Affordable Care Act in 2010, we heard from supporters about how opening up insurance coverage to more Americans would finally give millions of people access to quality care. We also heard from detractors that Obamacare would destroy the “greatest healthcare in the world.”

Both camps, of course, were wrong. Having insurance only means that someone else will pick up part of the tab, not that the care would be of high quality. And the United States certainly has had nothing close to the greatest healthcare in the world, just the most expensive.

Check out this 2014 data from the Organization for Economic Cooperation and Development. The U.S. was in the bottom half of most of these health measures both before and after passage of the ACA.

Source: Organization for Economic Cooperation and Development

Source: Organization for Economic Cooperation and Development

Yet, last week, the word “quality” popped up again at least twice in context of debate over the future of the ACA.

After a federal judge in Washington, D.C., blocked the proposed $54 billion merger between insurance behemoths Anthem and Cigna, Anthem put out a statement decrying the ruling. Anthem Chairman, President and CEO Joseph R. Swedish said that his company “has been a leader in providing individuals with access to high quality, affordable healthcare.”

Anthem certainly has provided millions of people access to care, but the quality and affordable parts are debatable. Technically, Swedish is right that his company has helped many people receive quality care, but Anthem has also paid for a lot of unnecessary and dangerous care.

A group called Patient Safety America has called medical error the third-leading cause of death in the U.S. I haven’t seen any data refuting that finding, though there is plenty of evidence suggesting that adverse events don’t always get reported and that hospitals aren’t always held accountable.

Swedish also argued that blocking the deal would, in part, “hurt American consumers by limiting their access to high quality affordable care, slowing the industry’s shift to value based care and improved outcomes for patients.”

That’s also debatable. Private payers certainly have been nibbling around the edges of value-based payment for years, but commercial insurers typically wait on Medicare before making major reforms. And now that the Affordable Care Act has given Medicare the statutory authority to shift away from fee-for-service reimbursement, other insurers are falling in line.

Which brings me to the other misuse of “quality” in healthcare last week.

MedCity News ran a Kaiser Health News story on hardline conservatives in Congress growing impatient with the slow pace of the effort to repeal and replace the ACA.

While voting at least 60 times to repeal the ACA knowing full well that President Barack Obama would veto any such bill might have scored some political points with their base, Republican leaders in Congress — and yes, the new Trump administration — are finding that there might be a little downside to yanking insurance away from 20 million people without providing a viable alternative.

There still are some staunch conservatives who don’t want to wait.

“Healthcare gets better and costs less once you repeal Obamacare,” Rep. Jim Jordan (R-Ohio), said at an event sponsored by the conservative Heritage Foundation. (That alone is delicious irony, given that the ACA’s individual insurance mandate is an idea that the Heritage Foundation itself developed as a more centrist alternative to the “managed competition” that the Clinton administration unsuccessfully pushed for in the 1990s.)

Here’s the thing: Healthcare wasn’t so great before the ACA, and it remains not so great now. Yes, spending is up, but the rate of growth has slowed from a decade ago, though some of that might have been due to people putting off elective care in the wake of the 2008 financial crisis.

And repealing the entire ACA without a replacement also would do away with numerous payment reforms that have made healthcare at least somewhat better. It would be terrible for patients — not to mention, fiscally irresponsible — if Medicare would have to resume paying hospitals for avoidable complications that result in readmissions.

So, let’s stop talking about “quality” as if it already is the norm in American healthcare, and let’s stop pining for the good old days.

Photo: Imgflip user NickMartin1