Author's note: The term "Obamacare" is used here to describe the Patient Protection and Affordable Care Act of 2010, and is not meant as a derogatory term. The White House has embraced "Obamacare," and in the interests of brevity and clarity, we do too.
Obamacare will cause controversy no matter what's said about it, and is likely to continue as a source of controversy long after the Supreme Court renders its decision this Thursday. Some say it goes too far. Others say it doesn't go far enough. Everyone, it seems, has a strong opinion.
Well, I've got my hip boots on, and I'm ready to wade into the muck. The title of this article might lead you to think I'm here to tear the law down piece by piece, but that's not the case. Instead, I'll offer three things Obamacare could and should have done, but didn't -- possibilities most have ignored while focusing on the law's most glaring flaws.
First failure: No tuition reform for doctors
The American medical industry has had no problem staffing up over the years. In fact, the sector has become so large that it may pose a threat to American prosperity. If the industry has a weak link, it's the most vital one -- there aren't enough doctors. It's not easy to get an MD, and any sensible health-care reform effort should have worked hard to strengthen that weakness. Obamacare, unfortunately, does nothing to address this critical issue.
Few professions have as beneficial an impact on the nation as doctors. Obamacare stymies their efforts with bureaucracy without making any effort to bolster their ranks or their morale. It's not easy to become a doctor -- nor should it be -- but the pursuit of that profession should garner more support from a law that places so many burdens on their shoulders after graduation. Consider that a doctor who graduates medical school today in the United States does so with an average student loan debt of $158,000.
Doctors in the United States tend to make far more than doctors in other countries, but considering the debt they pile on in order to reach professional practice, it's not all that surprising. How easy would it be to lighten the load? In the past decade, 161,698 doctors have graduated medical school. Forgiving all student loans to these graduates would cost the nation about $25.5 billion. That might seem like a lot, but Americans spent nearly $2.5 trillion on health care in 2009.
Forgiving a decade of loans to doctors would cost us one percent of our annual health-care spending, and when matched with a cost-reduction promise, the returns could amount to several times the investment. Easing the burden of the nation's doctors would also help attract brilliant, talented people who might have otherwise followed the lure of comparatively "easy" money into lawyering or an MBA.
Second failure: No benefits or subsidies for healthy living
Ask any fitness freak why America's health-care costs are so high and they'll be sure to tell you: It's the lifestyle, stupid!
The costs of unhealthy living place an enormous drain on the country's health-care resources, from the ravages of obesity to weakness and fragility brought on by a lack of movement. Government policies do nothing to ease the strain. Instead, we pour billions of dollars each year into subsidies for corn, which is then processed by the ton into virtually everything you eat. The cost of these corn subsidies is multiplied many times when unhealthy eaters become burdens on the health-care system.
The other side of this fat coin is the way we move -- or rather, don't move. The problem begins early, as only 4% of elementary schools and 2% of high schools mandate daily physical education classes. Far more schools have some P/E requirement, but few students are as active as they should be. Only 29% of high school students get an hour of physical activity every day.
The problems continue into adulthood, when many people take jobs that keep them stuck at desks every day. A shift to a more sedentary lifestyle has far-reaching health effects, not least of which is added weight. Work-related calorie burn has decreased by about 140 calories a day since the 1960s, which over time adds up to an extra 28 pounds of flab per person, according to a wide-ranging study publicized last year in The New York Times.
Eliminate corn subsidies, encourage the farming and sale of unprocessed fruits and vegetables, and establish stricter and more consistent exercise guidelines for the nation's public schools. While we're at it, why not offer businesses tax breaks to encourage healthy living among their employees? America's relationship to diet and exercise can have tremendous effect on national health trends, but few politicians want to talk about it. There's no need to force people to buy broccoli, but well-constructed inducements can make broccoli a better buy for families than a Big Mac.
Third failure: No forward-thinking health records database
The hip boots are pulled all the way up for this one. What we need is a national health records database containing everyone's medical history, including a full genomic sequence.
Efforts are already under way at both national and treatment levels to consolidate records electronically. The 2009 stimulus bill contained provisions to establish electronic health records, which are now being implemented by at least three-quarters of the nation's hospitals. This will help consolidate information and ease its flow across providers, which could go a long way toward eliminating bureaucratic redundancies and unnecessary costs.
What we need now is more information -- genomic information. I'm not saying this just because I want to drive business to Life Technologies (Nasdaq: LIFE ) and Illumina (Nasdaq: ILMN ) , although such an effort certainly would benefit these two sequencing pioneers. Cracking the mysteries of the genome is the next great step forward in medical science, and the more data gathered, the better.
Privacy advocates will no doubt recoil from this idea, but let's consider how much of your information is already out in public, and how much more useful that information might be to hackers than the knowledge of your genetic code or the fact that you had heartburn for a month back in '93. It's easy to talk about "big data" when it tracks frivolous things like browsing and purchase histories, or when used for purely corporate reasons such as optimizing the layout of a store or a website. Why not use big data to make America, and the world, healthier?
Creating a national genomic database might not be as costly as you might think. The cost of full genome sequencing is dropping so rapidly that it should be under $100 by 2016. At that price, sequencing every American would cost about $30 billion a year, still a small fraction of the cost of our annual health-care splurge. That data could be run through medical analytics to create far more effective and more precise treatments than those we have today. Matching medical histories to genomic information across many millions of individuals would unlock a wealth of data the likes of which medicine has never seen. In pursuit of big data, there's no bigger prize -- to improve everyone's health to its furthest possible extent.
Transforming health care won't be easy, and these are just three issues that I think Obamacare fails to address. You may very well feel differently. Maybe the answer is for government to provide nothing and to stay out of our way. Maybe everyone should be covered by the same public health care program. Maybe the answer, as usual, is somewhere in between. Whatever your opinion, I'd love to hear it.
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