The ACA’s policy changes represent real progress toward a better healthcare system, but we need to do much more. Americans still struggle to pay for physician visits, prescriptions and costly health insurance; face high deductibles; and navigate an inefficient, confusing system. Many are uninsured or underinsured, and the ACA has added to their stress.
We need to change the way we think about health care reform. Instead of giving more money to the government and hoping it does a better job, we need to put you—the consumer—in the driver’s seat, so that you decide which medical and insurance providers receive your tax dollars. In industry after industry, this approach works: choices and innovation increase; prices and barriers to access come down.
To accomplish this, we need to break the fee-for-service backbone and replace it with a payment system that supports value, including by elevating primary care. We need to discourage a lot of expensive, unnecessary procedures and encourage other activities that will improve outcomes at a lower cost to consumers, such as changing dietary habits and taking medications as prescribed.
To succeed, the new system must give physicians and hospitals sufficient autonomy to focus on what they know best. It must also reward innovators who offer services consumers value, and disincentivize aggressive behavior to shift costs or evade taxes. Finally, it must create a single market that eliminates rigidly segmented insurance markets—Medicare, Medicaid, CHIP, VA, small-group and large-group, individual and employer-sponsored, etc.
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