Thirteen years have passed since President Obama signed the Affordable Care Act, our nation’s last significant piece of healthcare legislation. Though the landmark law helped reduce the number of uninsured Americans and expanded Medicaid in many states, the bigger picture for healthcare remains bleak.
In recent years, the Covid-19 pandemic, along with the scourge of chronic disease and diseases of despair, has brought down our nation’s life expectancy by years. Meanwhile, the rising cost of care continues to strain American families and businesses.
Despite the relative lack of progress, many Americans are still holding out hope that either the government or private enterprise will provide an answer to the nation’s ongoing healthcare crisis.
To better understand the healthcare platforms of Democrats and Republicans, I had the privilege to moderate “Policy Perspectives: Fixing a Broken System,” a two-part program during yesterday’s Stanford GSB Healthcare Conference, held at the graduate school of business’ Knight Management Center.
Alongside presentations by some of the nation’s leading investors and entrepreneurial CEOs, I hosted back-to-back interviews with two leading political advisors.
Rohini Kosoglu is the former deputy assistant to President Biden and domestic policy advisor to Vice President Harris. Later, I interviewed Dr. Scott Atlas, a former special advisor to President Trump who’s currently a senior fellow in health policy at Stanford’s Hoover Institution.
Their perspectives were equally insightful and educational, although their approaches to healthcare reform could not have been more different.
Kosoglu, who also served as chief of staff for Kamala Harris, pointed out how government programs, particularly those made possible through Obamacare, have expanded healthcare coverage for tens of millions of Americans. Other Democrat-led efforts have addressed problems created by the “social determinants of health,” which include societal factors like drugs, violence and socioeconomic disparities that influence health. She also noted recent policies focused on making prescription drugs more affordable as Americans struggle to make ends meet. She also outlined the challenges of moving legislation through a divided U.S. Congress and the importance of bipartisan cooperation.
In contrast, Dr. Atlas feels the government has overstepped its authority in medicine and limited innovation as a result. He believes the American healthcare system doesn’t get enough credit for outpacing other nations in quality of care and innovation. In our conversation, he blamed the obesity epidemic for declining U.S. health and worsening clinical outcomes, not the current system of medicine. He recommended that our nation move to a system of individual-market, high-deductible insurance with more of market-based economy for services.
As moderator, I had to restrain myself on stage, as I see things very differently than either of these political advisors.
Whereas I believe the federal government hasn’t been as proactive as it should be—particularly in the areas of drug pricing and reforming care delivery—I also believe that unfettered corporate freedom leads to egregious prices (for drugs and hospitals) and harms patients (via opioid medications, smoking, etc.).
Fundamentally, I believe that capitation (prepayment at the delivery-system level as opposed to fee-for-service funding of medical care) aligns the incentives for both government and business. And once this methodology becomes the basis for how we pay for healthcare in the United States, doctors and hospitals will focus on preventing chronic diseases and avoiding their deadly complications (heart attacks, strokes, cancer), rather than simply treating the problems when they arise. Capitation incentivizes the adoption of effective health-IT systems, along with greater patient safety and more efficient approaches to healthcare delivery. And once these improvements are in place, I’m optimistic that our country will improve clinical outcomes, make medical care more convenient and provide affordable health coverage.
The current debate in Congress centers on reducing the federal deficit and addressing the upcoming bankruptcy of the Medicare Trust fund. Add to these issues the fact that our nation has 90 million people on Medicaid, and millions more who’ve gone bankrupt from medical bills, and I believe that a day of financial reckoning is upon us.
I hope policy leaders like Kosoglu and Atlas can convince elected officials to work together rather than driving further division.
I’d like to thank and commend Lexi Henkel, Laura Simko and Mac Findlay for organizing one the of the best healthcare programs that I’ve ever attended. I know the hundreds of attendees from the Stanford schools of business and medicine, and many from the community who joined, all learned a great deal and will apply the information to their careers. Spending the day with such bright and motivated students gives me optimism for healthcare’s future.
Photos by Oleh Pylyp via LinkedIn.
Listen to the Fixing Healthcare podcast
Sign up for my free monthly newsletter
* * *
Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s a Forbes contributor, bestselling author, Stanford University professor, and host of two healthcare podcasts. Pearl’s newest book, “Uncaring: How the Culture of Medicine Kills Doctors & Patients,” is available now. Follow him on Twitter @RobertPearlMD.
