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Opinion: Fixing our broken health care system, not perfecting it

Official White House Photo by David Lienemann
Joe Biden is the Democratic presidential candidate that has come closest to submitting the incremental solutions needed for real healthcare change, Dr. Vin Gupta said.

Political debate on practically every side of the aisle agrees that the health care system as it stands today is fundamentally broken. Fixing it, though, may require small, incremental changes different from what often makes headlines, argues a University of Washington educator.

Dr. Vin Gupta, an assistant professor of pulmonary and critical care medicine at the University of Washington, joined us on “Take Care” to discuss how the health care system is broken and how to fix it.

First off, it’s important to discuss why the health care system is broken, and Gupta said that, as complicated of an answer it is, it mainly centers around quality of care.

“Our political debate is so focused on how many people are covered, how many people are uninsured, how can we best fix that equation?” he said. “We don’t talk enough about quality of care and what we can actually do to improve the patient experience and, in doing so, hopefully minimize the number of times needed to [see a doctor].”

That lack of nuance, Gupta said, is problematic but also an area that can be readily improved upon right now with existing innovations. That’s because that, unlike the quantity debate, quality is not about politics.

“Improving quality of health care in the United States has nothing to do with philosophies on the role of government in health care like coverage does,” he said.

This situation is the result of history, Gupta said. Gupta has written that some of the same policies pushed by some of the Democratic presidential candidates and former president Obama are similar to the policies pushed by President Nixon in the early ’70s.

Nixon advanced what has been called Nixon Care, which Gupta said was a liberal version of Obamacare. Nixon Care was 100% federally subsidized, which is in stark contrast to the Affordable Care Act.

“That’s a drastic difference in 40 years between what a conservative president was trying to push forward and what a centrist president was ultimately able to pass through both houses of Congress,” Gupta said. “In 40 years we saw a shift in just the nature of our politics, what centrism in health care really means. … It means something very different today than it did during the era of President Nixon.”

Because of how health care stands now, it’s unlikely that the debate on coverage will be reconciled within the next few decades, but what is obtainable, Gupta argues, is improving quality of coverage. Unfortunately, the small solutions that will help make those improvements aren’t particularly flashy, Gupta said, which means they tend to stay off the debate stage.

“In my view, our politics when it comes to health care more broadly has devolved into how do you get the most likes on Twitter, how do you get the most donors to give you a few dollars on an online platform, which is to say, how can you be provocative versus how can you be substantive,” he said.

Gupta said he’s learned to value substantive stances and politicians that put forward pragmatic solutions that have a chance of passing both houses of Congress and making it into law, even if that’s not as appealing on social media.

"We have structural obstacles in our political system that prevent our elected leaders from taking bold, courageous stances on things like Medicare for all."

Bringing down the cost of health care in the United States, Gupta said, involves keeping in mind the many stakeholders within the system that prevent solutions like those in the United Kingdom and Canada.

Unlike these countries, the U.S. isn’t embracing technological changes to medicine and how digital can transform health care. This exact method, though, might be just what health care needs.

“How do we actually use the technologies that’s already in our hands?” Gupta said.

The Democratic candidate that comes closest to these solutions, Gupta said, is former Vice President Joe Biden. It’s important to acknowledge the progress of the Affordable Care Act, Gupta said, but also focus on how to improve it, and Biden has done that. Biden has focused on the incremental changes that might actually make a difference.

“That’s a very progressive platform, and I think it’s touching the boundaries of what is probably unlikely to pass both houses of Congress, but it’s also one of the most centrist platforms of any of the Democrat,” Gupta said.

Realistically, major health care reform in this country will be difficult, but it’s not unobtainable. Politicians have to be willing to take bold but unflashy stances in order to make a change for the better, but right now, there’s not much incentive to do so.

“The way we are going right now, in our current debate and our current crisis, I think what it’s going to take is structural, political reform,” he said. “We have structural obstacles in our political system that prevent our elected leaders from taking bold, courageous stances on things like Medicare for all.”

True reform, Gupta said, requires changing politics first, and health care will follow.