The debate over the future of healthcare in the U.S. is really a discussion about inequity, according to America’s Essential Hospitals president and CEO Bruce Siegel, MD, MPH, saying disparities will still need to be addressed even if the Affordable Care Act and Medicaid expansion remain in place.
Speaking at the American College of Healthcare Executives (ACHE) Congress in 2018, Siegel said progress has been made on inequities in healthcare, either through emphasizing more diverse leadership in hospitals or health systems or pushing population health. But he also argued inequity has been “hardwired into our system” for decades, dating back to compromises in creating Medicaid which made it less comprehensive in offering healthcare coverage to poorer American as Medicare did in covering seniors.
The ACA tried to address those issues, he said, though it fell short on Medicaid when states were allowed to choose to not expand eligibility. The 2017 moves to repeal and replace the law left Siegel “flabbergasted” by the estimated loss in insurance coverage and also how the final attempt—known as the Graham-Cassidy bill—would’ve impacted patients based on socioeconomic and health status by repealing a section of the ACA “which prohibits discrimination based on age, disability, quality of life and expected length of life.”
“Repeal-and-replace was the greatest assault on health equity in our lifetimes,” he said.
Siegel even likened the repeal efforts to “kidney stones—they didn’t care what was in it, they just needed to pass it.”
Healthcare disparities won’t end with the ACA, he argued, and some recent efforts from regulatory and industry may even exacerbate them. He used the example of the plethora of ratings and rankings of providers from CMS star ratings to lists released by the Leapfrog Group and U.S. News and World Report.
While he doesn’t dispute the positives of focusing on quality, he said current ratings don’t adequately adjust for socioeconomic factors or provide “useful information” to consumers. The same problems, he argued, exist in CMS programs aimed at quality improvement which harm safety-net providers.
“Penalizing cash-strapped hospitals for readmissions or other outcomes driven by that need will help nothing,” Siegel said, “while sending a very clear signal that there are places in America that providers should just avoid.”
Greater government collaboration could also advance efforts to fight inequity in healthcare, Siegel said, such as settling the long-standing “distrust” between hospitals and public health organizations.
He ended the speech on more positive notes, saying population health “is starting to have real meaning,” as physicians and administrators look for ways to address health issues in communities they serve rather than wait for patients to bring those problems to their attention. That may lead to an even larger discussion about the structure of the U.S. healthcare system.
“We’re on the brink of an even greater debate about whether this nation is now ready to build on this foundation and join the rest of the developed world in guaranteeing healthcare for everyone within its borders,” Siegel said.
John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.