So if anyone should understand the political hurdles still facing the 2010 Affordable Care Act (known by its detractors as Obamacare), it is Tom Daschle. And Tom Daschle sees broad areas of health policy consensus.
Lawsuits against and congressional opposition to ACA largely come down to disagreements over what role the federal government should play in the lives of ordinary citizens, Daschle said in a speech late last month at a retreat for Presbyterian Healthcare Services staff and volunteer leaders. Most people would agree that health care costs too much, is hard for many people to obtain and is of insufficient quality, he said.
“There is a very significant consensus about what our goal should be,” Daschle said. “We want to build a high-performance, high-value health care marketplace with higher quality, better access and lower cost. Period.”
Daschle also sees “a growing consensus about what the causes” of cost, access and quality problems are.
Health care financing and delivery is not transparent. “You can’t fix what you can’t see,” Daschle said. Since 85 percent of patient records are still maintained on paper, researchers and practitioners can’t access the data they need to evaluate weaknesses in care, Daschle said. Health care is delivered by multiple independent subsystems that don’t communicate with each other. Financial systems do not reward quality of care in part because it is difficult to identify when practitioners do a quality job.
One result is that a lot of unnecessary care is delivered. “About that there is little debate,” Daschle said. Some of that unnecessary care occurs when providers practice defensive medicine out of fear of being sued. He argued that health care providers who deliver the accepted standard of care ought to have a safe harbor from lawsuits. There should be non-judicial alternatives to resolving medical malpractice claims as well, he said.
Providers sometimes deliver unnecessary care just to generate fees, and some patients demand care they don’t need, Daschle said. Since the many subsystems that deliver care are not coordinated and one subsystem can’t always know what another subsystem has already done, some of the care provided is simply redundant.
ACA does little to disrupt what Daschle called “the collage of subsystems” that deliver care into a marketplace that is funded about half-and-half by public and private dollars.
Even so, Daschle said, “I would argue this is the most transformational moment for health care in American history,” akin to the establishment of Medicare and Social Security. “It is an uncertain time, but it is a time of immense opportunity.” The United States has a chance, using provisions of ACA, to “better utilize the resources we dedicate to health care,” Daschle said.
Daschle described health care as a pyramid. At its base are primary care, preventive care, diet and exercise. At its pinnacle are highly specialized and very expensive medical services. “Most societies start at the base and work their way up until the money runs out,” Daschle said. “The United States starts from the top and works its way to the bottom.”
He said ACA will improve care up and down the pyramid by assuring millions more people have access to coverage, by implementing accountable care organizations designed to better coordinate the subsystems that deliver care today, and by using Medicare to reward providers who improve quality of care and lower costs.