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Dr. Pate’s Prescription for Change

St. Luke’s Health System’s Journey to Transform Health Care

Dr. Pate Prescribes a Dose of Transparency in the National Health Care Debate

By Dr. David C. Pate, News and Community
July 4, 2017

I love the “Date” Citi® Double Cash Card Commercial.

In the ad, a couple goes on a date and each says exactly what is on their mind. The announcer concludes the commercial with, “Wouldn’t it be great if everyone said what they meant?”

That is where I am on the health care reform debate. Wouldn’t it be great if politicians said exactly what they were thinking? We then could have a national debate over the various policy positions.

Here’s why I’m in favor of more transparency in this debate:

Let’s start with the name of the Senate health care reform bill: the Better Care Reconciliation Act of 2017.

Sen. Mitch McConnell might have said, “People aren’t going to like this bill. We called it the Better Care Reconciliation Act so that at least some people would think they are going to get better care, even though there is absolutely nothing in the bill that improves the quality or safety of care.”

Not every law needs to improve the quality and safety of care. Let’s not pretend that a law does when it doesn’t.

Similarly, Secretary of Health and Human Services Tom Price has continuously contended that recent proposals will “put in place a patient-centered health care system.” After studying these bills, I am at a loss as to how they make care any more patient-centered.

Consider also Sen. Rand Paul’s comment that “Conservatives have always been for repealing Obamacare, and my concern is that this doesn’t repeal Obamacare.”

It might be more transparent to say something to the effect that “I am in favor of a full repeal of Obamacare. We can’t do a full repeal through the budget reconciliation process and a repeal will require 60 votes in the Senate, which is impossible. For these reasons, I won’t be voting in support of any Republican bill.”

Sen. Ted Cruz has said, “That should be the central issue for Republicans – repealing Obamacare and making health care more affordable.”

Is there anyone in the country who isn’t in favor of making health care more affordable? But for many Americans, the logical caveat is that they want the health care they currently have, just at a more affordable rate.

In line with the Citi® commercial, Sen. Cruz would say, “That should be the central issue for Republicans – repealing Obamacare and making health care more affordable, and by more affordable, I mean you will have fewer benefits than you have now, but your insurance policy will be priced lower.”

Wouldn’t it be refreshing if someone told the American people the truth and said, “The number of insured under the Affordable Care Act was less than the projection by the Congressional Budget Office, but that is because after the CBO estimate, Republicans challenged the law in court and the Supreme Court ruled that the planned Medicaid expansion in the ACA would have to be left to the discretion of individual states and could not be mandated.

“It was also because, after the CBO projection and in response to criticism regarding his promise that ‘if you like your plan, you can keep your plan,’ President Obama allowed grandfathering of certain plans, which meant far fewer people were compelled to comply with the ACA as written.”

What if our politicians were just honest and said, “The Jimmy Kimmel test (a reference to the late-night comedian’s tearful plea that we ensure that everyone can access care if they are sick or injured) is not the standard by which we will effect legislation. We cannot afford to cover everyone, and while we will provide for those who are most in need, we must cut back on entitlement spending if we are to decrease the federal deficit, and the way that we think we can best achieve that politically is to cut back on Medicaid enrollment and spending because many Medicaid recipients don’t vote.”

I think Sen. Mike Crapo did a good job when he said that the Senate plan’s proposed cuts to Medicaid would put Medicaid “on a sustainable fiscal path.” That’s great. Acknowledge the what – we are going to cut Medicaid – and then the why – because Medicaid is unsustainable and we have to get the federal deficit under control.

Now, we can face the facts. It’s what we would do in our personal lives if we determined we had to control our expenses and spending. In the national instance, we then can decide if we want to work toward this goal with a clear understanding that it will be at the expense of some in the Medicaid population. Americans can be trusted to make policy decisions if government will provide the facts and cease the hyperbole.

I don’t mean to say that no one tells us what they really think. Here is an example:

Gov. Jan Brewer of Arizona stated that cutting Medicaid will eventually cause private insurance premiums to rise because people that lose coverage will seek treatment in hospital emergency rooms. “We’re going to pay for it one way or another; there are no free lunches.”

I love this honesty. It sets up the policy issue for debate without presuming the answer from the American people – do we want to pay for Medicaid through our taxes, or do we want to pay for uninsured people’s care through increased insurance premiums?

About The Author

David C. Pate, M.D., J.D., previously served as president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009 and retired in 2020. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.