Is this Round 3 or 4? Is it “Repeal and Replace”, or is it “Reform”? I can’t remember anymore.

Once again, the American healthcare system is under attack by opponents of the Affordable Care Act, and once again, the new proposal being considered (the so-called Graham-Cassidy Health Care Proposal) is hugely unpopular among the majority of Americans and almost every single insurer, physician group, and non-partisan healthcare advocacy organization (you know, the experts) who have bothered to weigh in (again). The President of the American Academy of Pediatrics, Fernando Stein, MD, calls this old scheme with a new name on it “dangerous and ill-conceived”:

“This bill may be disguised under a different name, but it contains the same dangerous policies as the legislation that failed to advance out of the Senate earlier this summer. In fact, Graham-Cassidy goes even further in its attacks on Medicaid.

“By turning Medicaid into a block grant, capping its funding and ending its expansion, this proposal would have devastating effects on the nearly 37 million children across the country who rely on the program. Medicaid is a lifeline for children from low-income families and with special health care needs, and this proposal would leave them with nowhere to turn. Graham-Cassidy also eliminates subsidies that have helped almost 9 million people afford health insurance, and allows states to opt out of a wide range of protections put in place by the Affordable Care Act, like guaranteeing coverage for those with pre-existing conditions and eliminating lifetime caps on coverage. Any legislation that would leave more families uninsured, or without insurance they can afford or that meets their basic needs, is unacceptable…”


That statement should be enough, but there’s more from Dr. Stein, who says that “pediatricians will continue to focus on the children we care for as this process unfolds, and we will not stop speaking up on their behalf until we see legislation that puts them first:”

“Throughout this debate, pediatricians have spoken up for and advocated alongside children whose health hangs in the balance of the harmful policies of this proposal and the bills that came before it. These are real families with real stories whose lives will be turned upside down if these policies advance. We count on our legislators to support policies that put children first, and this proposal leaves them worse off.


We can’t solve this problem — do we fix the flaws in the ACA by reforming it with new legislation; scrap it altogether; go with a completely different approach (like last week’s unveiling of the Medicare For All, single-payer system)? — unless we agree on a few things first:

  1. It is in America’s public health interest that every American is insured for essential health services and catastrophic health events.
  2. It is in America’s economic interest that every American is insured for essential health services and catastrophic health events.
  3. We should be able to agree on most (if not all) of what constitutes essential health services and catastrophic health events.
  4. When we say “every American” should be covered, we mean it: “ALL Americans”.
  5. Whatever solution we agree on, it should be open to modify as flaws are revealed and unintended consequences arise.
  6. Solutions should be negotiated and debated in good faith, with citizen-patients’ good health as the top priority.
  7. Whatever solution is agreed to, it is going to be expensive. (There is no “free” in healthcare.)


I think most of us can agree with these seven items. There is probably a lot more common ground I haven’t mentioned. There are legitimate points, however, that will not be easily reconciled, such as:

  1. Who will pay, how much will it cost, and will it be fair?
  2. Will we continue to have employer-based insurance AND also have (expanded) public-based insurance?
  3. Will the current profit-based model that makes the American healthcare system unique among all other developed nations survive?
  4. Will physicians have more autonomy than they have now in determining what is best for their patients, or less?
  5. Will patients have more autonomy than they have now in determining what the best treatment options for them are?
  6. Will clinical outcomes improve, stay the same, or get worse with the bill we end up with?


Will Congress succeed in finding enough common ground to move forward and improve the healthcare situation in the United States? Will any new policy “put children first?” That is the hope of the 66,000 members of the American Academy of Pediatrics — this pediatrician included.


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