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The Keckley Report

Dear Delegates: Who Cares?

By July 18, 2016March 1st, 2023No Comments

By Thursday of this week, at least 60 political stars and wannabees in the GOP will have had their day in the spotlight in Cleveland. Next week, the same will play out in Philadelphia where the Democrats will host their televised infomercial.

The news networks will be there in full force hustling for ratings and hoping to reverse their viewership decline of one third (3.5 million viewers) from 2008 to 2012.  Reruns of “Two a Half Men” and “Big Bang Theory” easily beat the convention tallies as the Romney-Ryan duo fell short of upsetting the Obama-Biden ticket.

I am a healthcare guy and a news junkie. My remote is hotwired to CNN, FNC, MSNBC, Bloomberg and CNBC, and I watch C-SPAN when I need to dial it down on the news of the day. I am fiercely independent politically and will be among the few who watch this week.

But here’s the deal: the story line for both Cleveland and Philadelphia should be “who cares?” Here’s why:

The two party system in the U.S. has lost credibility with the masses and appears to most incapable of finding middle ground on anything. Even the simplest issues escape compromise, like Zika funding with left-over Ebola funds. Little wonder the majority of Americans and even higher proportions of anticipated voters call themselves independent.

Congress has lost respect and trust. Trust and respect is at its lowest ever: per Gallup, only 8% trust Congress, the lowest rated institution in our society for the fifth year in a row. The majority of Americans see Congress as a collection of power-seekers who speak from party-talking points and vote the will of their party bosses (lest they be hidden from camera’s when it’s show time).

The primary process is not the real show. Voters on both sides know that the primary contest is reality TV where a winner demonstrates greatest star power to stand out from the crowd. And voters know that candidate promises in the primary are different than promises in the general election. And most vote knowing the promises will not likely be kept.

Healthcare issues are complex. They’re non-partisan. They’re more important than the two party system and winning elections. Let’s face it. Politicians can get elected by saying little about healthcare though it’s 17% of the GDP, a third of the federal budget, 11% of the civilian workforce and 14% of household discretionary income. Focus-group tested talking points on both sides dominate healthcare coverage, since neither party wants to specify its plans and their underlying assumptions about the system’s future.

Little wonder most will not be watching. A New York Times/CBS News poll last week conclude that two-thirds of the country are simply disgusted by the process and are holding their noses until the election passes.

The urgency of addressing the issues like healthcare can’t be overstated: health costs went up 5.6% last year and will escalate at a record pace for the next generation. The Medicare hospital trust fund faces insolvency in 2025. One in four households can’t afford care they know they need, and the safety and quality of what we provide in our system is highly variable and in some cases embarrassing. It’s a kitchen table issue, but you’ll probably hear little in Cleveland this week judging from the GOP’s recent output.

In preparing for Cleveland, I read Convention Chairman Ryan’s “Better Way”, Donald Trump’s 7 Point healthcare plan, and reports from the GOP Platform Committee’s deliberation last week. I reviewed the 2012 GOP Platform, a 54 page “We Believe in America” wherein 4 pages were devoted to healthcare. And the GOP’s pre-Affordable Care Act platform of 2008 wherein 6 pages were devoted to “Healthcare Reform: Putting Patients First”.

There are common themes across these, like streamlining and eliminating redundancy in federal health programs that serve the poor, fixing the Veteran’s health programs, using tax credits to encourage purchases of insurance by the uninsured, off-loading Medicaid from the fed’s to states via block grants, eliminating individual and employer mandates, emphasizing primary care and addressing chronic illnesses, morphing Medicare into a premium support program over time and others.

What can be deduced from these artifacts is the big bet the GOP makes as the underpinning of its health policy: the U.S. healthcare system is a marketplace best served through a loosely regulated private system of providers and payers. It is not a universal right nor a federal program. It is a marketplace where there are winners and losers among producers and competitors who sell services, and individuals and families who can afford to purchase them.

Next week, in Philadelphia, chapter two of the quadrennial political Woodstock will take place with a hefty smattering of speeches by the Dem’s rising superstars and political heavyweights taking their shots at the GOP. Their platform is being developed as I write.

But the real question for delegates to both is who cares?

In the primaries, healthcare was a prominent among the Democratic combatants who offered ‘Medicare for All’ and ‘Protect the ACA’ as their rallying cry. It was muted among the 17 GOP primary contestants save for their collective oath to ‘Repeal and Replace’ the Affordable Care Act and Donald Trump’s insistence he’d leave Medicare alone.

The masses are tired of political speak and wise to candidate pandering about healthcare. They’re looking for fresh answers and honest discussion about these issues. They know the health system’s costs are increasingly out of reach for most and it shuns transparency. They know it’s two tiered: one system for those who have insurance and those without. And they know something’s gotta’ give.

Perhaps the answer is this: a summit of non-partisan thought leaders armed with a common set of verifiable facts who will be sequestered after the election to offer solutions that are binding on the next Congress and administration. And among its responsibilities: the naming of a National Health Board to oversee its implementation. Possible? Unlikely. The politics of healthcare trumps the policy of healthcare. But moving health policy outside the political arena is not likely: our elected officials jealously guard their power to make laws and command media attention to advance their agenda’s.

Joe and Jane Six Pack think the healthcare system operates in its own universe.  Andy Slavitt’s announcement last week that quality reporting in the MACRA payment system for physician payment might be delayed from the January 2017 start date escaped their attention completely. They think all doctors get paid well and don’t give a hoot how. They don’t care that the CBO announced health costs for next year will be up 5.8% last week, dramatically higher than overall economic growth at 3% and higher than the consumer price index. What else is new? It will matter when their insurer translates that to a double digit premium increase or their coverage is stopped altogether. That the Illinois CO-OP announced it was shutting down matters to the 350,000 it covers but the rest won’t know or care. And the Bureau of Labor Statistics’ Producer Price Index report last week that drug makers hiked their prices 9.8% in the last 12 months (second highest category in the economy just below investment advice) is not on the radar because Joe and Jane are accustomed to three years of double digit drug cost hikes.

There’s a new website that’s getting attention: This organization espouses that Campaign 2016 sucks because the two major party candidates are disliked and distrusted, and the political process fundamentally flawed. Regrettably, the majority think the healthcare system sucks, and see no reason to watch these conventions for an informative exchange of ideas.

Memo to Delegates: While you’re reveling in your moment of hyper partisanship the next two weeks, no one will be watching.

It’s regrettable since Americans care about our healthcare system and are accustomed to political brinkmanship that has paralyzed national discussion about its future.