Feds Still Have Important Work to Do Shaping Healthcare

Guest Editorial

As controversial and frustrating as it may be, the federal government’s role in modernizing American healthcare is far from over.

Healthcare occupies an unusual role: it is technically a private service subject to free market forces, yet in many ways it is insulated from consumer demand and market pressures of the sort that impact more traditional industries, like retail or entertainment. Patients, by and large, don’t choose to get sick or injured—it happens, and they react to it by soliciting professional care.

The absence of price transparency means patients aren’t usually able to shop around for care; in many regions, a small selection of hospitals also means choice is doubly limited. Adding in provider networks and health insurance contracts, and the notion of patients being capable of exerting any influence over their healthcare providers becomes more theoretical than visible in action.

A captive market like this can’t compel providers to modernize, or adapt their practices and technology to evolving needs and expectations. If not the individual consumers themselves, who else can provide the pressure and incentives for the healthcare industry to change?

According to the latest data, individual households pay for 28% percent of the roughly $3 trillion America spends on healthcare every year. The only other sponsor whose share of the bill is that high is the federal government, who also happens to pay for 28% of the total. In terms of sheer purchasing power, that puts the feds on equal footing with the actual individual consumers.

But healthcare is also subject to a litany of regulations, from certification standards for physicians, to privacy laws protecting patient health data, to much-discussed Affordable Care Act (ACA) and its impact on insurance rules and standards. Before the bill is paid—before any services are even rendered to patients—it is clear that the federal government is the overwhelming source of pressure, influence, and oversight for the healthcare industry.

What this means is that, despite assertions that the free market will take care of everything, consumers simply do not have a strong enough voice or concerted enough affect to take the healthcare industry closer toward true patient-centered, accountable care, nor to push the adoption of the necessary technology and associated standards to complete the digital transition.

It isn’t a question of what the federal government should do, so much as what patients alone can do.

That goes a long way to explaining why, for example, adoption rates of Electronic Health Records (EHR) systems shot up to 97% in 2014—directly in line with federal standards enumerated in the Meaningful Use program to bring digital health records into clinical use.

The problem the Meaningful Use program has run into—and clinicians and patients alike have pointed out—is that compelling providers to buy into an upgrade, purchase a piece of software, or manage billing through EHR platforms doesn’t fundamentally change America’s healthcare culture. One-time incentives of the sort rewarded through Meaningful Use don’t change how doctors and hospitals approach patients or care.

That kind of lasting change can never happen when it is a matter of incentives passed directly between the government and providers; patient-centered care requires a patient-centered culture, not government-centered self-interest.

Fortunately, increasing patients’ roles in healthcare can be aided significantly by technology. Implementation thus far has been largely provider-centered; utilization of electronic health data is now moving toward a more patient-centered model. Patients’ needs and desires are now part of the equation in determining what information should be retained in an EHR, how it should be shared across the continuum of different specialists and providers of care, and what kind of security should be in place considering this growing mobility.

These are all practical questions evolving naturally from the new technology. Both the federal government and providers have an interest in ensuring patient interests are a part of the conversation—after all, that is the ultimate measure of whether they are successful: are patients getting healthier, and are they happier with their care? It is important for lawmakers and federal officials to use their current, disproportionate influence over the healthcare industry not to exert control, but to move the whole system toward greater patient engagement, finally allowing healthcare consumers to enjoy the same direct relationship they enjoy as consumers in every other industry.

Federal government to date has played a huge part of managing, influencing, and shaping healthcare in America. It is time for government to use its position to elevate the role, and responsibility, of patients in determining what the future of healthcare looks like.

Edgar Wilson is an Oregon-based independent consultant who writes on trends in education, healthcare, and public policy.


2 responses to "Feds Still Have Important Work to Do Shaping Healthcare"
  • January 19, 2016

    I personally believe that Government is there to help the people not to control them. This is nothing but breach of trust with people. I don’t know and under which circumstances Govt. Has taken this decision but what I believe that at least area like healthcare should be in control of government not in control of money making machinery. There should be a proper rules for such areas and which can’t be changed by individuals influence. What I also believe in such cases direct involvement of common people must be taken in consideration. This is totally a result of capitalist attitude. If country like USA will do it then it’s really very disappointing because it will ultimately impact the many other countries too.

    Thanks, Avanish

  • June 1, 2017

    This is very interesting- in good economy the government has active role in providing a milieu which is conducive for society. However the threshold tends to vary and often depends on the economic position of the state.
    Thanks Katherine

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