Tired of health reform politics? EMBRACE this new idea

Thursday, June 29, 2017 | Larry Sobal

 

As expected, this has been another interesting week for health care. Senate Majority Leader Mitch McConnell recently unveiled the GOP plan, known as the Better Care Reconciliation Act (BCRA), and hoped it would be voted on and passed before the Senate’s July 4th recess. After a busy Monday and Tuesday, he announced that the vote would be postponed until after the recess. It appears that it did not have the support it would need to pass. And, the proposal appears to have little public support, as indicated by the latest poll. Forty-eight percent of participants in the poll said they thought the House bill was a bad idea, while just 16 percent said it was a good idea. Since the Senate version does not differ significantly from the House version, it’s fair to assume that there would be similar sentiment.

I, for one, am tired of the political stalemate in Washington, the lack of transparency, and the lack of bipartisan discussions. To borrow a line from the 1976 movie Network, "I'm mad as hell and I'm not going to take it anymore." With the voting delay and in light of the large public resistance, wouldn’t now be a great time to take a different approach to repeal and replace? If you share my sentiment, read on to learn about an alternative idea.

Gilead Lancaster is a cardiologist in Connecticut. Maybe he’s a New England pragmatist, maybe he’s a closet health policy genius. What I do know is that Dr. Lancaster, along with a varied group of “out of the box” thinkers, have applied some Yankee ingenuity to craft a different proposal for health care reform, and I think it is something very much worth learning about.

Their ideas, outlined in the book EMBRACE: A Revolutionary New Health Care System for the Twenty First Century, takes a totally different tack in proposing a health care model for the United States. EMBRACE stands for Expanding Medical and Behavioral Resources with Access to Care for Everyone. Here are the foundational elements of the book:

• EMBRACE was developed by a nonpartisan groupof health care professionals, which differentiates it from any of the current Washington rhetoric
• The model offers cradle-to-grave guaranteed basic universal coverage for Americans for some defined services, with options to expand coverage, which I will explain below
• EMBRACE is designed to incorporate 21st century concepts such as science-based guidelines
• It relies on three principal innovations that are designed to work together:

A. A 3-tiered health coverage system
B. A web-based, nationwide Health Information Platform (HIP)
C. An independent National Medical Board (NMB) that oversees the nation’s entire unified health care system- thereby creating a “Single System” health care

• The NMB, the main component of EMBRACE’s infrastructure, will be an independentnon-governmental body like the US Federal Reserve. It would be chaired by a physician appointed by the president and approved by the Senate, and comprised of physicians, nurses, experts in public health and health care administration.
• All health care-related federal agencies and programs related to health care delivery and payment, such as Medicare, Medicaid and the Veterans Health Administration, will either be eliminated or integrated into the NMB. 

The EMBRACE plan is not a single payer approach to health care. It has aspects of a universal coverage model, but only in regards to Tier 1. Let’s explore the three-tiered approach.

The foundational principles of having health care designed and governed by physicians and other health care leaders, not our elected officials, are spot on.

The Tiered Benefits System is comprised of three levels:  

1. Tier 1 covers all life-threatening conditions and all life-extending or preventive services. Because Tier 1 conditions are the most serious in terms of both personal and public health, they are covered by a form of public insurance that is managed by the National Medical Board. This coverage is automatic and universal and does not depend on age, gender, employment status, preexisting conditions, or even military service; it covers the entire population from cradle to grave. Examples would likely include things like heart attacks, cancer, pregnancy and severe depression. This tier also covers treatment of conditions shown to increase life-threatening illnesses such as high blood pressure, diabetes and high cholesterol. It also covers testing used to rule out a Tier 1 condition.
2. Tier 2 would cover conditions that affect quality of life but have not been shown to affect life expectancy or increase the risk of other life-threatening conditions. Coverage for this tier could be obtained from different options of private insurance through an employer, though an individual insurance marketplace or be paid for out of pocket. Examples likely would include things like osteoarthritis, low back pain, irritable bowel syndrome and testing not included in Tier 1.
3. Tier 3 would cover “luxury” services that are mostly paid out of pocket like cosmetic surgery, Lasik vision enhancements, etc., essentially the way these services are utilized and paid for today.

I know what some of you are thinking and can feel your distain through cyberspace: “It would never work in the U.S.,” or “There is no way that the Federal government will give up control of health care,” or “The insurance companies would never allow this to happen.”

As I understand the EMBRACE model, it offers a bipartisan method to accomplish basic universal health coverage while eliminating some of the politically incendiary programs such as Medicare, Medicaid and the Affordable Care Act. Furthermore, it continues participation of for-profit health insurance companies with some “free-market” features without compromising the patient’s health or adversely affecting the publicly funded system.

As the book explains, the benefits of EMBRACE would be unprecedented. For Americans, it will provide free basic health care services from cradle to grave with automatic enrollment, no out-of-pocket expenses and identical access to every licensed clinician and every hospital. Consumers can upgrade their basic (Tier 1) coverage through private insurance offering easily comparable private plans, which would be significantly less expensive than current private plans. It would allow for universal portability of all coverage from job to job and state to state, and would have significantly lower out of pocket costs. As you can imagine, it also significantly reduces administrative burdens.

I found the book to provide some extremely compelling ideas. Yes, there would need to be some details worked out, but the foundational principles of having health care designed and governed by physicians and other health care leaders, not our elected officials, are spot on. In my current state of frustration, I’m ready for some revolutionary health reform, not the same old politics. How about you? Read the book and let me know what you think.

 

Illustration: Lee Sauer

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Larry Sobal is Executive Vice President and a Senior Consultant at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and health insurance. Larry consults, writes and presents on topics relevant to transforming physician practices and health systems. His weekly blog post comes out on Thursdays and can be accessed at www.medaxiom.com.

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