December 21st, will be the shortest and darkest day of the year.  It seems a bit appropo that during these dark days we ponder the effects of the decades long shakeups that have happened in Healthcare.  Since long before the passage of the Affordable Care Act (ACA), the US healthcare environment has been under pressure to make significant changes.  Now, just as we were getting our sea legs from the changes forced by the ACA, the shift in administrations has thrown healthcare into a new set of challenges and stress.

I doubt you’ll find many people Democrat or Republican who would say the ACA is a perfect law.  On both sides, most people would readily admit that changes need to be made so that this law is more efficient and less costly for providers.  But it also brought many very important and beneficial changes such as the “insurance for all” concept.  Since it’s passage however, it has been under non-stop attack and demand for total repeal without any solid plan for replacing it.  As the new administration is pondering doing just that, hospitals, providers, and insurance carriers, who are finally seeing the benefits of the ACA are now having the rug pulled out from under them again.

Political Leaders Aren’t Helping

Political leaders constantly make statements that they plan to push for cuts in Medicare and Medicaid which has sent ripples through primary care and hospital associations alike.  At the same time, the current administration and congress have chosen this time to ignore deadlines for funding Community Health Center programs whose mission is to care for the uninsured and underinsured (whose numbers will increase drastically if their plans are passed).  

Loss of Safety Nets

Providers, hospitals and other healthcare programs are stressed out wondering how they are going to keep their doors open when all of their funding sources dry up.  As usual, primary care will be most affected by these changes.  Just the loss of thousands of Federally Qualified or Rural Health Centers would leave this country in a serious lurch, especially in the vulnerable areas they serve.

Safety-net hospitals will find themselves in serious trouble as well.  We have already seen a significant loss due to closures of safety-net rural hospitals in states that didn’t expand Medicaid.  New legislation designed to decrease readmissions, although a great idea at normal times, puts an additional strain on these safety-net hospitals.  This is especially true considering that these hospitals tend to serve the patient population most likely to be readmitted due to social issues out of control of the hospital and providers.  MACRA also throws a wrench into the works potentially costing these programs millions of operating dollars.

Are There Brighter Days Ahead?

We are certainly facing dark times, but are there brighter days in the future?  The answer to that is a clear maybe.  Much will depend on whether our political environment continues to be polarized.  If Republicans and Democrats continue focusing only on their ideological platforms and refuse to work together, or bills are bullied through Congress by the majority (regardless of which side is the majority), then we will likely continue to find ourselves in deeper and deeper water.  That being said, if our national leaders were to start working together and actually revert back to a time when bipartisan politics led to effective change, then issues as important as healthcare could avoid the crises that have been building for decades.

There are no easy answers for healthcare, which is probably why these days seem so bleak.  There are rays of light in the darkness, though. Programs such as quality based care, prevention and wellness, and patient accountability are potential ways of managing the rising costs.  Accountable Care Organizations (although not a perfect program by any means) promise to provide solutions for managing costs as well.

If history shows us anything, it is that the American electorate will eventually step in and stop the madness.  Our politicians should ask themselves if they are willing to sacrifice everything for their individual short-term ideology or if they are willing to compromise for the long-term betterment of the country.  The social sciences show us that polarized relationships don’t accomplish anything but dysfunction.  This is not different for Congress.  Both the House and the Senate are made up of Americans voted into their position by the electorate.  No one is going to get their way all the time so these elected official MUST stop the childishness and start working together.  

Hope Springs Eternal

Maybe I’m an optimist, but I like to think the healthcare crisis will soon begin to come out of the darkness.  December 21st is the darkest day of the year but no matter how dark that day gets, no matter how cold or bleak, we know that the next day will be brighter even if it is only slightly so. We need to hold our elected officials accountable and demand that they work together to solve the problems we face as a nation.  In so doing, every day will be a little brighter than the one before.  Soon the cold solstice night will be a distant memory and we will all be looking forward to spring.