As part of the "Millennial Priorities for the First 100 Days" series, a call for President Obama to finish the health care overhaul he began with the Affordable Care Act.
While the principle focus of this year’s presidential campaign was clearly the economy, the election carried more profound implications for the future of American health care then any other area of policy. The choice was clear: would we see the reaffirmation of the Affordable Care Act and with that, an opportunity for its provisions to be phased in at last? Or would we see a rapid repeal and systemic overhaul under the ascendant Romney administration? With the reelection of President Obama, the signature health care legislation of his first term is secure. But to truly reform our health care system, he still has much more work to do in his second term.
Because of President Obama’s historic win, he will be able to fully implement provisions that extend health coverage to over 30 million Americans, end denial of care on the basis of pre-existing conditions, and allow young Americans nationwide to remain covered while continuing their education. But despite this leap forward, significant challenges to our health care system remain. Though the Affordable Care Act tackled the coverage problem, concerns about ever-rising health care costs--and the concomitant budgetary pressures--remain at the forefront. Moreover, debates about end-of-life care, prevention, and the proper role of medical technology in our health care system remain unresolved.
Some of these health policy concerns will take years to tackle. Others must necessarily extend beyond even President Obama’s term limit. But there should be a particular focus on issues regarding health science and technology that we must tackle in the first 100 days, while the electoral mandate remains clear.
The consensus among health economists of all stripes is clear: medical technology is the single most significant driver of rising health care costs in America. These advancements, while making significant gains in extending our lifespans and improving the quality of life for the U.S., simultaneously impose significant cost burdens and threaten the fiscal sustainability of our health care system. The Affordable Care Act takes steps to address this concern, most notably by funding so-called “comparative effectiveness research,” a systematic means of assessing the therapeutic efficacy of clinical treatments and weeding out those that exhibit no health benefits despite their substantial costs. This isn’t rationing—it’s rational.
However, due to political pressures, “Obamacare” contained no provision or mechanism for the results of such comparative effectiveness research to be implemented in a meaningful way. Even the one model that it did call for—the Independent Payment Advisory Board, a “Federal Reserve” of medicine—has been effectively neutered by congressional officials and only served an advisory role. If we are to truly and systematically address the cost burdens of health technology in a meaningful way, what we need is a form of health technology assessment, such as the one pioneered by the National Institute for Health and Clinical Excellence in the United Kingdom. Until then, we will have a patchwork policy at best, and a downright nonexistent one at worst.
Realizing the benefits of these technologies will also necessitate a regulatory overhaul. Despite (occasional?) failures and controversies, the Food and Drug Administration deserves great acclaim for helping to ensure the safety of the American patient for the last century. But the critical nature of this mandate does not obviate the benefits that could be derived from a deep overhaul of the FDA approval process. For instance, there is ample opportunity to bring the FDA into the 21st century, with opportunities to authorize statistical modeling techniques that allow for smaller, leaner, and quicker clinical trials guidelines, and by mandating that the results of all drug trails be published online. These are measures with potentially broad bipartisan support.
Policy has also fallen short in the development of these technologies. Case in point: funding for the National Institutes of Health has largely remained flat in recent years, even under the Obama administration. Yet the importance of biomedical research in maintaining America’s edge in innovation cannot be overstated. It’s no coincidence that over half of the Nobel Laureates in medicine have come from within our borders; it is this edge on health science and technology that has allowed life-saving treatments such as statins, angioplasty, and MRIs into the clinic. As other nations begin to ramp up their investments in biomedical research, it is critical that the U.S. not lose its position of global leadership.
These health policy areas represent means for the president to reaffirm his vision for our health care system. Admittedly, with a looming fiscal cliff, persistently high unemployment, and issues of energy and immigration beginning to enter the national spotlight, turning back to health care may carry with it great political risk. However, while the Affordable Care Act was initially highly polarizing and contentious across the electorate, there is emerging evidence that as its provisions are phased in, support among Americans is growing—and fast. Reaching across the aisle early with these bipartisan policies to further advance our nation’s health care can cement the president’s principle legacy, setting the tone for another transformative term. Ultimately, their impacts will extend well beyond the next 100 days or even the next two years, for the path to a truly 21st century health care system lies ahead.
Rahul Rekhi is a student at Rice University and the Senior Fellow in Health Care Policy for the Roosevelt Institute | Campus Network.
Barack Obama image via Shutterstock.com.