Health experts debate PPACA’s greatest flaw

ATLANTA — Debates at trade shows can be funny things.

The one that opened this year’s Institute for HealthCare Consumerism 2014 Forum & Expo, in fact, boasted a clash of titans in The Heritage Foundation’s John Goodman facing off against Emory University’s Kenneth Thorpe.

Problem is, when you get two of the country’s bigger authorities in health care reform on stage, and they actually agree, it’s tough to squeeze much tension out of what’s left.

Right out of the gate, Goodman and Thorpe readily agreed the Patient and Protection and Affordable Care Act is a flawed piece of legislation.

The disagreements, however minor, started cropping up from there and all boiled down to two simple, but disparate, perceptions of what’s wrong with the law.

For Goodman, health care in this country is an infrastructure designed with “perverse economic incentives” in which “doctors are slaves to a third-party system.” And that’s the crux of his argument: that the third-party payers, whether they’re insurance carriers or government programs, are the fly in the ointment, suppressing pricing and giving rise to “non-price barriers to care.”

As far as Obamacare is concerned, Goodman pointed to what he calls an impossible mandate, especially in an environment where health care costs are increasing faster than incomes. He also blasted PPACA’s “bizarre system of subsidies,” worsening “perverse incentives” with regard to patient behavior and a growing trend toward two-tiered health care delivery in this country.

Still, Goodman conceded the exchanges are here to stay and said he’s been telling any Republican who’ll listen to focus on repair rather than repeal.

“The exchanges are here. We just need to deregulate and denationalize them,” he argued. “We have to forget about repeal. We have to transition.”

Among his other solutions, Goodman argued against both the individual and employer mandates as well as instituting a standard, across-the-board subsidy for everyone, which would streamline enrollment.

Finally, Goodman pushed for a universal fund with leftover subsidies for safety-net institutions while also allowing individuals to buy into Medicaid.

"It would be real insurance for people with prior conditions,” he explained.

Thorpe, on the other hand, blasted the entire health care system.

“The payment model is broken. The delivery model is broken,” he said. “And the preventative model is nonexistent.”

Thorpe’s bogeyman was behavior, as he pointed to a doubling obesity rate over the last 30 years, which he said accounts for roughly 10 percent of the increase in health care spending in this country.

Which, of course, helps fuel the explosion of chronic illness.

“Most of the money in our health care system is spent to treat the chronically ill,” he said.

He pointed to a health care system — in both delivery and funding — that was borne out of a need for acute, occasional treatment that's somehow morphed into a system serving chronic habitual patients, a model he declared unsustainable.

Thorpe’s behavior-centric solutions are much simpler, starting with an elimination of a fee-based funding model and an increased focus on prevention.

Overall, the “debate” revealed that the disagreement over PPACA isn’t about its past, but its future.

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