Health reform is dead. So what can we do now?

Health care reform as it is typically discussed in America is dead for now. By “as it is typically discussed,” I mean broad “big picture” health care reform, which deals primarily with how we organize payments: government vs. free market, multi-payer vs. single payer, profit-based vs. not-for-profit. The Democrats tried. Obamacare’s shortcomings stem largely from the fact that neither President Obama nor the larger Democratic Party had the political power or the will to deliver the radical changes necessary to fix the American health care system. And now the Republicans have tried (at least briefly). But Ryan-Trump-Care was quickly aborted (pun intended), also for lack of support.

And for the foreseeable future, that is the way it is going to be. There is a four-way split in Congress that makes progress on the highest-level politico-health care issues impossible. The most radical right-wing Republicans, the so-called Freedom Caucus, will only agree to a full repeal of all things Obamacare. Moderate Republicans can’t stomach that; it is a Republican house divided. It is much the same on the Democratic side. Moderate Democrats are committed to preserve and “improve” Obamacare, though they don’t seem to have many ideas how to do that. And the more left-leaning Democrats, led by Senator Bernie Sanders, insist on a single-payer system for all.

But with the current alignment in Congress, none of these approaches has the support necessary to pass. We are at an impasse. It will take a major re-alignment, that is, a huge election victory (or two or three) for one of the four groups to make this aspect of health care reform politically feasible.

Do we just give up for now? I don’t think that is advisable. Too much is at stake. And there are many other significant ways, all far less politically charged, and therefore more politically possible, that we could improve the American health care system.

One of the most important ways we could improve things is through administrative simplification. Modern health care workers and patients alike are caught in a huge tangle of administrative paperwork, confusing rules, and confounding regulations. It is estimated that one-third of every dollar spent on health care in America goes towards administrative costs. Therefore, reducing the administrative burden could significantly lower the overall costs of health care to the nation (or we could increase the amount we spend on actual medical care). Administrative simplification would be relatively easy and should be politically palatable. Done well, it could be wildly popular with both patients and physicians.

The American medical billing and coding system is long overdue for just such a makeover. Getting paid for even the most basic medical goods and services is a multi-stepped, convoluted nightmare that creates huge and unnecessary costs, and invites mistakes and abuses. Ridiculously complicated coding systems and documentation requirements are the rule and have the same effect. It is a distraction for all medical professionals almost every moment of the day. Medical practices must focus on billing and payment issues almost more than medical care.

Coding and documentation requirements should be markedly streamlined, and most billing should be eliminated in favor of point-of-care payment cards. This would represent an incredible improvement and money-saver for American health care.

The next area of focus should be health care computerization. A generation of American physicians is now forced, by government mandate (the dreaded federal meaningful use program, which started in 2011), to use electronic health record (EHR) software systems that are not ready for prime time — they don’t work well, slow things down, and cost too much. Many physicians now spend hours, often late at night, catching up on chart notes and other tasks because their EHRs were too slow to use during actual patient care hours. EHRs have simply failed to deliver on their great promise. And because of their huge costs, most physicians are stuck with what they have.

Putting next-generation, usable, affordable, and interoperable (systems can communicate and share information with one another) EHRs in the hands of all American physicians needs to be another focus of health care reform. This is crucial if we hope to improve the quality of medical care in America (and nearly impossible without it).

There are many other ways we could improve the nation’s health care system even without broad payment reform. I will mention one way we could lower the costs of care in the U.S. that does not receive enough emphasis — healthier Americans. It is estimated that two-thirds of every dollar spent on actual medical care (non-administrative spending) relates to preventable chronic diseases, such as heart disease (the nation’s number one killer) and diabetes. The best way we could lower the costs of care in this country is to reduce demand — by preventing such preventable diseases. Health promotion should be a centerpiece of our national health care policy. Schools, and even more importantly, places of work should set aside time every day (it could be 5 minutes of every hour) for structured exercise. We must go beyond past efforts to create a new American health culture. The economic impacts could be huge. And, as I said in a recent BBC interview, your best bet until things get better in health care is, “Don’t get sick.”

These are ideas that both Republicans and Democrats, and everyone in between, could love. And they could revolutionize American health care. Today.

Matthew Hahn is a family physician who blogs at his self-titled site, Matthew Hahn, MD.

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