Healthcare Reform and the Survival of the Fittest

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  • 06/28/2012

Healthcare Evolution and the Survival of the Fittest

It doesn’t stop with the Supreme Court.  Now we actually have to do something.

One of the big mistakes of the Affordable Care Act (“Obamacare”) was to try to solve all of our national healthcare problems at the same time and on a national scale. The Individual Mandate was just the poster child for many of the law’s fantasy solutions.

Now’s the time to stop talking about healthcare “reform” and start focusing on the need for healthcare evolution.

But the Supreme Court ruling notwithstanding – a grandiose national solution is never going to work. While it sounds good politically to say, “we solved the healthcare problem” – it’s just not feasible.

Post the Supreme Court ruling many see problems, but there’s also opportunity.

The opportunity is to realize that the way we can evolve healthcare is by recognizing that it must be done locally – on a state-by-state level. When it comes to reform, states are the laboratories of invention. (Welfare reform and the “Wisconsin Works” success comes to mind as a stellar example.)

But, just as a “one size fits all” national model is a naïve chimera, so too is the hope that one state’s success in healthcare will be equally workable in any other member of the Union. The many positive achievements of “Healthy Indiana”  (which requires enrollees to contribute up to 5% of their gross income to an account used to pay for medical expenses – with the state picking up the rest) may not translate to larger states such as New York, Texas or California. Needless to say, there are many lessons to be learned from the failure of “Commonwealth Care” in Massachusetts (such as the danger of providing insurance without ensuring access to a physician).

If a key goal of healthcare evolution is broader coverage at lower costs, one national program that does offer valuable lessons for the path forward is Medicare Part D (the Medicare prescription drug benefit). Part D applies free-enterprise principles to the nation’s health-care system (letting competition drive down prices and increase choice and quality) rather than operating like a government-managed utility.

Part D is a resounding success among seniors (as measured by participant satisfaction pushing 90%), below budget costs (the price of Part D over the next decade is expected to be nearly $120 billion less than originally estimated) and lower than expected premiums (in August 2011, HHS announced that premiums would be slightly lower in the drug program in 2012).

Smart partnership between government and the free market works.

It works at keeping costs low and – most importantly – improving care. As JAMA reported,  Implementation of Medicare Part D was followed by increased use of prescription medications, reduced out-of-pocket costs, and improved medication adherence.” And this, in no small measure, significantly reduces more drastic medical interventions -- which in turn reduces our overall national health care spending.

The Supreme Court’s ruling notwithstanding, the President should grant waivers to all 50 states to opt out of the ACA’s dictates and restrictions and allow them to develop their own strategies for healthcare evolution.

It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.

-- Charles Darwin


Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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