America needs to set aside ideologically driven approaches to healthcare, argues William Cayley

Finally, after much waiting and a fair bit of political posturing, we now have the much ballyhooed Republican proposal for replacing Barack Obama’s Affordable Care Act (ACA). Thankfully, with the proposed American Health Care Act (AHCA), we actually have a constructive proposal rather than simply a plan to demolish a system that has been in place for the past few years. However, the responses to this plan have been at best underwhelming.

While the new proposal seeks to maintain some of the popular provisions of the ACA, such as letting adults in their early 20s stay on parents’ insurance, and banning refusal of coverage due to pre-existing conditions, it also takes a different approach to some of the economic realities the ACA sought to deal with. For example, the AHCA would impose increased insurance premiums on those who seek to purchase coverage after previously letting it lapse, rather than requiring a fine for those who do not have coverage.

Unfortunately, the responses that we’ve seen in the news to the AHCA tend to focus on whether it is “too progressive,” or “Obamacare 2.0,” or other similarly ideological responses. What seems to be lacking in all of the responses is an effort to truly find a constructive way to come together and deal with the challenges facing our healthcare system.

An “article of faith” for political conservatives at present is the assertion that “Obamacare is a disaster.” While it seems clear that there is room for improvement in the ACA, it also seems patently untrue that Obamacare has been an all out disaster. An analysis published last year in the NEJM noted that since the introduction of the act in 2010, the proportion of uninsured Americans has fallen from 16% to 9%. Medicaid accounts for approximately 60% of the coverage gains made under the ACA and the other 40% are attributable to the law’s premium subsidies.

Since most folks on both ends of the political spectrum seem to agree that there is need for improvement in our current healthcare system, and since there are documented successes under the ACA, it seems a shame that we cannot set aside ideologically driven approaches to healthcare. If we could overcome political agendas, then we would have an opportunity to form a grand bargain that focuses on achieving “winnable battles” in the healthcare system (as the US Centers for Disease Control and Prevention did when they focused their efforts on addressing six priority areas of public health).

When I’m treating a patient, I’m not concerned about whether he or she is liberal, conservative, or of any other ideological bent. My primary concern in treating a patient is to diagnose the illness at hand and arrive at a reasonable, evidence based treatment plan.

It would be a refreshing change of pace, and frankly much better for our nation’s health, if our leaders could set aside political agendas and ideologies and instead focus on defining key problems; appropriate goals; and evidence based, workable solutions.

When we can come together and apply evidence based solutions to dealing with health needs on both an individual and public basis, then we may actually see progress in improving the health of our nation. 

William E Cayley Jr practices at the Augusta Family Medicine Clinic; teaches at the Eau Claire Family Medicine Residency; and is a professor at the University of Wisconsin, Department of Family Medicine.

Competing interests: I declare that I have read and understood BMJ policy on declaration of interests and I have no relevant interests to declare.