A cure for ACA fatigue syndrome

With the Supreme Court set to make another momentous ruling over the Affordable Care Act, there finally seems to be some public consensus over the landmark health care bill — puh-leeze, let’s move on.  Except for a hardcore constituency of ACA haters, the country is simply fatigued over the debate, now entering year seven. In just one example from public polling, 59 percent of voters said the law has had no direct impact on their family’s lives. In other words, for most people the law is a shrug of the shoulders. Meanwhile, the House has conducted 56 repeal votes since 2011, cue stifled yawns throughout America.  

So what’s next for the health care debate post-Supreme Court? Our suggestion is one that could unify the warring political parties and connect with average people again: improving the patient experience.

{mosads}Health care decisions can be bewildering, frustrating, and worrisome even in the best of circumstances. Individuals must make life-altering choices under physical and emotional duress. Physician instructions are often complicated and divorced from other maladies a patient may have. Providers often derive more economic benefit from over-treating than getting it right the first time. All of this and more conspires to make the patient experience less certain, more painful, and more costly.

Ultimately, health care is intended to help people stay healthier for longer or recover more quickly from illness or injury. Thus, the next stage of public policy should focus on removing the obstacles to getting the right care so people have consistently better health outcomes. And the reason why policymakers could unite behind this goal is not just so people have better and healthier lives, but because doing so saves a lot of money. Wasted care is one of the principal drivers of our bloated health care system — a system that is driving premium increases, government overspending, and suppressing wage growth.

Here’s an example of one idea for a woman diagnosed with breast cancer. Her treatment may involve a difficult choice between a lumpectomy and a mastectomy. She is in a bit of shock, as a doctor gives her advice that she is not prepared to consume. But doctors at the Dartmouth Hitchcock Medical Center in New Hampshire have figured it out. They give women a “pre-visit” medical discussion guide to review before they meet with a surgeon about treatment options. The guide includes a DVD that shows how women with breast cancer determined the best treatment option for them. She can watch it at home, with family, with friends.

When allowed to make an informed decision, most women choose the more conservative lumpectomy. Patient surveys found they felt their care was better compared to those who did not use the discussion guides. If used uniformly, the guides would also save money — trimming $11.4 billion from Medicare over 10 years for use in just four common ailments. This is simply because patients making informed choices yields better outcomes. 

Let’s look at Type 2 diabetes, which affects 29 million Americans at a cost of $245 billion and countless years of lives sacrificed to suffering and shorter life spans. Right now, the patient experience goes something like this: through the lens of the health care system, you either have diabetes or you don’t. There is no effective in-between switch that catches millions of people who are pre-diabetic and steers them into care that would push off the onset of this dreaded disease by years, decades, or forever. Yet all it would take is a simple blood test and a treatment protocol. 

If federal law encouraged health plans to report on diabetes screening and cover proven prevention programs the way they do for breast and colon cancer, more people would learn about their risk and many would adhere to the simple dieting and exercise measures to avoid the disease. Everyone is better off. Individuals are healthier and happier; providers avoid complicated cases; taxpayers save close to $10 billion over 10 years. 

Improving the patient experience is the commonsense way to clear out myriad obstacles to quality care that contribute to massive amounts of health care waste — estimated at more than $800 billion each year. By removing obstacles to quality health care, policymakers can make cutting waste into a policy agenda, not a public relations slogan, while directly improving what patients get out of health insurance coverage. Third Way will be working to create that agenda over the next year. 

No one knows how the Supreme Court will rule on the ACA, but either way, Democrats and Republicans will need a new script on what to do and say on health care. Despite ACA fatigue, people still have very specific frustrations with the care they are getting. And the obstacles they face — from not knowing what a procedure will truly cost, to not having their doctors on the same page, to not getting the care that’s right for you — are not only visceral to the individual, but amount to wasted dollars in health care that concerns policymakers on the right and left. By putting the patient experience first, Congress can ensure people stay healthy, get better quicker, need less care overall, and save more money. Who could oppose that?

Kessler is senior vice president for policy at the centrist think tank Third Way, and Kendall is senior fellow for health and fiscal policy.