Five Principles for the Future of Healthcare

Bert R. Mandelbaum, MD, DHL (Hon)


May 03, 2017

The failure of the US Congress to repeal and replace the Affordable Care Act (ACA) in March illustrated an important problem in the way that politicians are thinking about healthcare. Politics should not determine how we care for people in need. Rather than trying to accommodate our healthcare system to a political ideology—whether it is capitalism, socialism, or libertarianism—we should start with what the patient needs and build from there.

The patient is not in the center of the maze we call the ACA. The patient is off to one side and the physician is off to the other side. Despite their protests about expensive risk pools in the ACA exchanges, the five biggest US health insurers have done well since the act was implemented. Collectively, their annual profits went up 17%, from $12.8 billion in 2013 to $14.6 billion in 2016.[1,2,3,4,5,6,7,8,9] That $1.8 billion profit was lifted from the pockets of patients and providers.

Table. Change in Top 5 Health Insurers' Profits Under the ACA, in Billions of Dollars

Insurers 2013 2016 % Change
UnitedHealth $5.67[1] $7.29[2] 39
Anthem $2.49[3] $2.47[3] -1
Aetna $1.91[4] $2.30[5] 23
Cigna $1.48[6] $1.90[7] 36
Humana $1.23[8] $0.61[9] -127
TOTALS $12.79 $14.58 17

What did the consumer get? Higher premiums. If you put the patient first—not lobby groups, not payers, not the president—then we will do what we need to do.

Everyone is going to be sick or injured sometime. We must do whatever we can to keep healthy people healthy and take care of those who are not. Rather than focusing on being for or against Donald Trump's healthcare plan, let us focus on the health of the American people.


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