Good Healthcare Design is Participatory
And It Doesn’t Come From a “Group of Guys in a Backroom Somewhere”
The American Health Care Act (AHCA), which I have described in a previous post, is a healthcare bill that proposes to repeal the Affordable Care Act.
Read this tweet by Andy Slavitt, the former acting administrator for the Centers for Medicare and Medicaid Service, for important details about the impact of the AHCA.
It is estimated that:
- 24 million individuals on the individual market will lose coverage
- Kids, seniors, individuals with disabilities, and low-income individuals will lose coverage
- 7 million individuals will lose their coverage through work
- Individuals will be charged more if they have a preexisting condition and there may be lifetime caps in health insurance coverage
This health bill, if passed, will have far-reaching life or death consequences for millions of Americans over the next few decades.
Unfortunately, in May 2017, Congress passed the AHCA, and the bill is now sitting in the hands of the Senate. Read this tweet from Senator Ron Wyden which describes the differences in how the Senate considered the ACA in 2009, compared with what is currently happening with the AHCA:
With the ACA, there was great opportunity for public deliberation through hearings, markup, and Senate Floor Debate
Read Senator Claire McCaskill’s description of the hearing process for the ACA:
Deliberation about the ACA was participatory, which represents good healthcare design
There is nothing participatory about the current process with the AHCA
Watch this powerful video of Claire McCaskill asking Senator Orrin Hatch why there won’t be any public AHCA hearings:
McCaskill states:
“Will we have a hearing on the healthcare proposal?”
“And when you say that you’re inviting us — and we heard you, Mr. Secretary, just say, ‘We’d love your support’ — for what? We don’t even know. We have no idea what’s being proposed.”
“There’s a group of guys in a back room somewhere that are making these decisions.”
“There were no hearings in the House. We’re not even going to have a hearing on a bill that impacts one-sixth of our economy. We’re not going to have an opportunity to offer a single amendment.”
That’s right, our healthcare is being crafted by a group of guys in a back room somewhere
This is what the Republicans have shared with Democrats and the public about the AHCA:
Other Senators and health policy wonks are asking important questions:
Why is there an utter lack of transparency about the AHCA?
As Andy Slavitt describes in the Washington Post:
What to do with a bill that is clogging your agenda but only 8 percent of Americans want you to pass and members of your own caucus swore was dead on arrival?
According to Slavitt they are using the tools of “Sabotage, Speed, and Secrecy”. They have made the process for the AHCA deliberately anti-participatory. The bill is being kept hidden from the public, and there is a mad rush to get the bill to a vote before there is time for a public backlash.
Read more about the details:
● Speed: As he watched House members scrupulously avoid constituents while on recess, McConnell clearly recognized that his best bet would be to hold a vote before the July 4 recess in hopes this would minimize pressure on vulnerable senators such as Nevada’s Dean Heller — who won his seat by a mere 12,000 votes in a state where more than 200,000 will lose Medicaid coverage.
So last week McConnell deployed Rule XIV, a fast-track procedure that bypasses the committee process and moves the bill directly to the floor. Just as in the House, we’re on track to have a vote with no hearings (there were more than 100 for the ACA). Knowing the coverage loss will be significant, McConnell plans to vote within only days, or possibly even hours, of the release of the CBO score. Moving fast leaves opponents, and the public, with no time to catch up to the details.
● Secrecy. None of this will work if the content of the bill cannot be kept secret for as long as possible. A small group of Republicans is amending the House bill behind close doors. And for all the talk of having the Senate start over and fix the bad House bill, their reported changes appear to be minimal, and to follow the blueprint laid out by Senate Majority Whip John Cornyn (R-Tex.) that: “80 percent of what the House did we’re likely to do.” The ACA’s expansion of Medicaid would end. The caps on Medicaid spending imposed by the House bill would remain. With state approval, insurers would still be able to offer Swiss cheese policies that drop benefits people with preexisting conditions need most.
The Republican leaders are very explicit about their anti-consumer, anti-participatory process:
Senate Republicans are working to finish their draft health care bill, but have no plans to publicly release it, according to two senior Senate GOP aides.
“We aren’t stupid,” said one of the aides.
They aren’t “stupid” enough to engage with their US constituents? Seriously? And you said that this bill was supposed to “help” Americans?
Here is your call to action:
Today is national call in today to flood the Senate phone lines:
Use the Trumpcare toolkit: https://www.trumpcaretoolkit.org/
Use Resistbot: https://resistbot.io/
If we don’t, this could be our future ☹
I tweet and blog about design, healthcare, and innovation as “Doctor as Designer”. Follow me on Twitter and sign up for my newsletter.
Disclosures: JAMA Pediatrics, Unitio, Grant funding from Lenovo.
