By Jeff Margolis
As we start to emerge from the dark COVID cloud, there were some rays of sunshine in terms of the progress that healthcare made in 2022.
Congress acted in a bipartisan manner to fund research and vaccines and, oddly enough, spent little energy arguing about whether people deserved healthcare or not.
The Inflation Reduction Act of 2022, signed into law by President Biden in August, included important health provisions. Among them: lowering prescription drug prices in Medicare through price negotiation with manufacturers; requiring drug companies to pay rebates if prices rise faster than inflation for drugs used by Medicare beneficiaries; capping out-of-pocket drug spending for beneficiaries in Medicare Part D at $2,000 annually; and extending for three years the enhanced Affordable Care Act subsidies that Congress passed last year as part of the American Rescue Plan Act.
In the second half of 2022, there was enough confidence in vaccination and control measures around COVID-19 to start thinking about a new normal in healthcare. Data affirmed that those who maintained better health and well-being fared more favorably than those with underlying conditions and less healthy lifestyles. But it also reminded us that sometimes, even very fit people are overcome by novel diseases.
Looking ahead to 2023, Americans deserve a healthcare system that supports health in our daily lives and doesn’t only fix us when we’re sick. It is the actions we take regarding nutrition, fitness, sleep, mental health, relationships and financial management and how these factors are affected by social determinants that make up the vast majority of what governs our health and total well-being.
Yet, our healthcare system treats sickness with limited support to prevent illness.
It’s time to move from sick care to healthcare, beginning with having a broader perspective on benefit plans. Medicare, Medicaid, military and commercial plans need to be looked at through the lenses of physical health, mental health, social health, financial health, and to the extent possible, individual purpose. These categories should start to show more clearly in descriptions of benefits in addition to doctor visits, hospital visits, drugs, etc. Employers, who already have a belief system in total well-being, need to communicate the broader set of total health and well-being benefits more clearly and educate their employees on what is available.
The Centers for Medicare & Medicaid Services needs to take a step back and look at how less costly support for lifestyle and daily living (nutrition and reducing loneliness) can dramatically reduce the cost of traditional medical care. And consumer permissions to combine non-healthcare data with healthcare data in the best interest of their health need to become commonplace when enrolling in health benefits.
In 2023, large employers will zoom ahead of governmental approaches to health benefits. They will address total well-being while emphasizing primary care connections to consumers through digital, virtual and physical means.
Predictably, politicians will keep publicly attacking pharmaceutical companies and insurance companies as the cause of the economic challenges to healthcare. But they will work together in the background as private industry supports the innovation imperative.
Decision-makers in the healthcare industry and government must get on the same wavelength more often. But let’s take solace in the fact that elected government officials, policymakers and employers are starting to understand that healthcare is broader than just providing access to reactive sick care.
Imagine a world in which the healthcare system actually works with people to improve their total health — a world where healthcare becomes proactive instead of reactive.
Jeff Margolis is the author of “Not Just in Sickness … But Also in Health: Moving Beyond Sickcare to Health Optimization for All.” He wrote this for InsideSources.com.
