The National Affordable Care Act (affectionately known as ObamaCare) has not exactly achieved the great benefits it was supposed to provide.
Putting politics aside, let’s look at the evidence without all the rhetoric. The design and construction of the plan were flawed and have reaped untold damage on the nation . This bill was passed by questionable means and was deceptive in the way it was portayed to the voters. Voters did not get to keep their plan or doctor and the costs went up not down. Employers reduced employees to part-time status to avoid the exaggerated costs of this plan. And yet the political discussion on whether this bill should be repealed and or replaced is still largely argued along party lines from hardened immovable positions.
We owe our patients something better. Rather than arguing along party lines I propose that we rally around common goals!
The only common goals that makes sense to me is, Does the plan provide value to all the stakeholders of healthcare in our nation?
Value essentially means the ability to produce more value than it costs. Value is a construct that has three components.
Price (P)
The first component is the price or cost of the product or service. In this context the price includes not only the dollars that something costs but the amount of time, energy, enthusiasm or aggravation that a stakeholder has to give up to use the product.
Service/benefit (S)
The second component is the service provided or benefit received in addition to the actual product or service. In this context this means does the stakeholder receive peace of mind, better health, lower stress, longer life, or some other benefit a a result of using the product or service.
Perceived Value (PV)
The third component of the value equation is the perceived value of the product or service. In this context the perceived value is a measure of how badly the stakeholder wants or needs the product, How does it make them feel? Does it fit with their morale, cultural or religious traditions? Does it complement or antagonize their lifestyle?
The Relative Value equation
These three components interact in a very specific way to create the relative value of different healthcare choices. The P and S components add to each other to create a measure of value. The ideal relationship for a stakeholder would be to discover a product or service that offers the maximum benefit (S) for the lowest possible price (P). Given the economics of supply and demand a product that was high benefit at a low price will likely be a successful product in the marketplace. I submit therefore that Obamacare has largely failed because it created the worst possible result of High cost and low benefit compared to previous options for most people. The wild card of perceived value also proved to be a problem because for many people the program was not wanted and infringed on their perceived constitutional protected liberties such as the right to freedom of religion.
The Solution
Only someone who resists analyzing the real data would continue to argue that Obamacare as designed has been beneficial to the nation. If that’s what you believe then God Bless You. But wouldn’t it be better if we moved towards a system that actually provided better care at a lower price? Wouldn’t it be better if we provided a system without onerous penalties, convoluted tax credits, red tape and massive bureaucratic restrictions on private practice?
The 5 Stakeholders
In the health care marketplace there are 5 sets of stakeholders. 1) The patients and their unpaid Caregivers, 2) The licensed providers of care, 3) The payers for health care (Such as insurers, governments) 4) The regulatory agencies that regulate health care and 5) the secondary suppliers that provide goods and services to the other 4 stakeholders. Each of these stakeholders has a different point of view on what the value of a healthcare product is.
The Viewpoint
The patient wants the product that best eases their suffering. The medical providers want to get paid fairly for the service they render. The payers want to use their resources wisely to provide care for large groups of patients by staying within budget. The regulatory agencies want to be able to monitor and evaluate compliance and stay within their budget. And the secondary suppliers want there to be a market for their goods and service.
The discussion
So let us stop the partisan bickering and focus our energy and attention on providing value to all sets of stakeholders. But having this discussion without understanding the relative value equation essentially means there is no way to come up with a good answer. Ultimately I believe the primary focus of a national policy has to focus on creating a system that provides value to patient and allows the medical providers to be fairly compensated for their time and efforts. Without that any system will implode.
