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President's Perspective: We can do better than this with Ted Townsend, UnityPoint Health Cedar Rapids President & CEO

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When I took a delegation of UnityPoint Health – Cedar Rapids board and physician leaders to the United Kingdom nearly a decade ago we went to study a totally different health care system at a time of turmoil and anticipated reform of our American national health care policy. Months later the Affordable Care Act was passed by Congress and we embarked on this generation’s version of health care policy reform. Looking back over the past century there has been some major effort of such reform virtually every decade. We are now in the midst of this decade’s debate.

The goal of our trip was to broaden our board’s perspective on different ways to address healthcare at a national level and to see it not just from the legislative or political perspective but to see it in action, on the ground talking to doctors, patients and regulators to hear both the theories about how it was supposed to work as well as watch and see how it actually did. We learned a lot. Some of it was good, like the UK’s greater emphasis on primary care and less technology, their ability to keep costs low and quality up. They were years ahead of us in implementing a single electronic record system that could be used by every patient anywhere in the country. There were no billing departments because there were no bills. We also learned some of the bad. The system was owned by their government, funded by heavy payroll taxes and run like the huge bureaucracy it was. We saw patients in cramped, old four bed wards where pairs of patients faced each other in full view of each other all day long in three-walled spaces about the size of a good office. It was not pleasant.

But the single most remarkable thing we learned about the UK’s health system we learned from a taxi driver. No one loves their nation’s health system, but when asked about his our driver pleasantly rattled off both its benefits and frustrations (including the very modest cost he paid for additional insurance that would allow him to opt out into a private hospital or doctor if he needed to). What struck me most, however, was that he did this calmly and without fear. He didn’t live in fear of his nation’s health system. He didn’t live with the constant worry of falling through a crack in the system, or a pre-existing condition. He didn’t live in fear of his employer not offering this benefit. He didn’t live in fear if he or a family member had a bad health outcome that he could be financially ruined.

That is everybody’s fear in this country and it’s about to get worse. Not because the Republican’s American Health Care Act (AHCA) is necessarily better or worse than the Democrat’s Affordable Care Act (ACA) of seven years ago. It’s because of the uncertainty. No one knows where this is going to end up, who will have insurance or how much they’ll have to pay for it. Can it be taken away? Will pre-existing conditions lead to denials of insurance like before the ACA? Even if they have insurance, will they be able to afford it, the co-pays, the deductibles?

And that’s just the patients, the public. Employers are wondering and worrying if this reform will cost them more or less than the last one. Providers, doctors and hospitals like UnityPoint Health - Cedar Rapids, are wondering how they’ll be paid, what services will be covered, what new regulatory or data requirements will be layered on organizations who already use nearly a quarter of their staff and resources simply chasing the payments for services already rendered.
There will undoubtedly be much consternation, shouting and gnashing of teeth in the Senate over the next few weeks as they hash out their version of the AHCA. There will be lobbyists aplenty filling any ear they can bend on how to advantage, their piece of the puzzle. They will all be speaking of doing things in the patient’s and public’s best interest. The drug companies will be there. The insurers, and yes we providers too. The lists of special interests connected to this one sixth (nearing one fifth) of our national economy are simply too numerous to mention. And not the least among them are those same publics, those patients and families, who have grown entitled to, or frustrated with some element of the current system. There really are few innocents here.

But what seems to get lost here is that while each individual party works to protect their individual interests, the whole becomes ever more byzantine, fragile and uncertain, and that very uncertainty that leads to fear, fear of being left out or overlooked or abused, becomes the real disease no one has a cure for and everyone is suffering from. American exceptionalism shouldn’t stand for being the worst health care system in the industrialized world. We can do better than this.

One of my favorite Churchillian quotes is the oft mangled one where he said something along the lines of: “You can always trust the Americans to do the right thing. After they’ve tried everything else.” Let’s hope we can skip a few steps.

Ted Townsend
President and CEO
UnityPoint Cedar Rapids