What a mess.

President Trump made statements about healthcare reform while running for office that promised better healthcare that would be much more affordable, and he specifically said that we must also take care of the poor and those that cannot afford healthcare.

The type of healthcare reform he described would have been a wonderful opportunity for a deal between moderate Republicans and moderate Democrats.  What the President wanted was achievable as a true bipartisan effort, marginalizing the extreme right and extreme left.

Instead, the bill that moved forward in the house was largely a return to the dysfunctional healthcare system we had before Obamacare, while it added the expense of covering pre-existing conditions and some of the subsidies provided by Obamacare.  It did little to improve the quality of healthcare or reduce costs.  It did not even tackle prescription drug cost reductions or enable insurance to be sold across state lines.

How was this bill going to improve the quality of healthcare, and how would it drive down the costs?

And even this proved controversial, splitting the Republican party into those that thought it went too far in subsidizing healthcare for the elderly and poor and those that thought it didn’t go far enough in eliminating subsidies.

What a mess.

The fact is that the House bill lacked any imagination or innovation.  What happened to actually reinventing healthcare for the 21^st century?

No one is talking about the need to fundamentally reinvent the delivery of healthcare, embracing new technologies, earlier detections of problems, less costly interventions, incentivizing wellness, producing much better and lower cost outcomes. What ever happened to the use of telemedicine, or to developing innovative programs to drive Americans to live healthier lives, promoting wellness as a way to substantially drive down healthcare costs?

We can deliver more responsive and available healthcare services at much lower costs but only if we reinvent how we deliver those services. New automated techniques can handle many functions of the healthcare system more often, more accurately, less intrusively, more conveniently and much more cost effectively, while maintaining a personalized connection between patient and doctor.  New powerful uses of ‘big data’ can identify best practices and provide a clear path to better outcomes.  As a result, doctors will be able to return to delivering care, relieved from the burden and crushing load of bookkeeping and other activities that can be automated or done by others.

Companies like Google, Facebook, Amazon, and Uber have reinvented the world by fundamentally changing the way people find what they want, form communities and connect together, shop, or travel.  Visionary leaders like Elon Musk are reinventing multiple industries by completely rejecting old methods and constraints in favor of profound new approaches that slash costs yet deliver better products and services.

Where is the Elon Musk or Steve Jobs of healthcare?

Healthcare is due for reinvention.  If we want to bring down the cost of healthcare 50% or more, we have to change the way healthcare works.  Elon’s SpaceX today launches satellites at less than 25% of the cost NASA incurred, and expects this cost to drop to around 10%.  Imagine the impact on our economy if a new improved healthcare system emerged at half the cost of the current system.

Ross Perot used to say “You have to start with a clean sheet of paper”, and it would be great if we could simply throw out the old healthcare system and replace it with a revolutionary new healthcare system. Unfortunately, our healthcare system represents 20% of the economy and there are too many industries, services and jobs dependent on the current system.  We can’t instantly create a new replacement healthcare system and transition to it.

What then should we do?

Let’s start by defining the new healthcare system, as if we had a clean sheet of paper, and then define a transitionary strategy to move us to it on a constantly improving basis.  The full transition might take 5 or 10 years, or perhaps the time window for complete transition is 25 years.  And as we’re implementing the transition, we can’t be afraid to make changes to it, embracing even better options that emerge, correcting approaches that proved to be wrong.

In the meantime, the legislation we pass now should be viewed as positive incremental improvements and corrections to the existing system; band-aids that are important and helpful, but not the end-game.

Let’s make Healthcare great again!