By Donald R. Frey, M.D.
Omaha World-Herald, January 26, 2021
As America tiptoes into the unknown of 2021, an event will soon occur that will be largely unnoticed.
Just three years ago, the corporate giants Amazon, Berkshire Hathaway and JP Morgan Chase announced they would join forces to create a new health care company called Haven. Revolutionary in its scope, Haven would use market forces to create disruptive innovation that would bring down the costs of employer-based insurance.
In the minds of many, this was long overdue. Each year, rising health care costs were eating into both corporate bottom lines as well as employee take-home pay. Omahaâs Warren Buffett had already thrown down the gauntlet when heâd called health care costs the âtapewormâ inside American economic competitiveness, adding that costs âwere the biggest single variable where (America) keeps getting more and more out of whack with the rest of the world.â
Now, the collective strengths of Buffett, Jeff Bezos and Jamie Dimon (not to mention their combined $4 trillion in company assets) would be brought to bear on the cost crisis. The health care world braced for a shock wave of innovation.
In short order, the highly respected Harvard surgeon and author Dr. Atul Gawande was hired to spearhead the project. It was widely anticipated that Haven would use such items as value-based purchasing and massive economies of scale to radically alter health care delivery.
Instead, the whole thing landed with a flop.
To date, thereâs been no evidence of meaningful innovation. Gawande left the project after less than two years, and last month came this announcement â Haven would cease operations in February.
Advocates of market-based health care are now scratching their heads. If three of Americaâs most successful business leaders canât solve our countryâs health care cost dilemma, who can?
In the coming months, the issue of health care will echo through the halls of Congress. With the COVID pandemic spotlighting our national deficiencies, the scope of the Affordable Care Act (the ACA, or, Obamacare to some) will again come into focus. Democrats, who crafted the original legislation, will seek to bolster it, and Republicans, who came within a whisker of demolishing it (save for the courageous vote of John McCain), will try to diminish it.
But will any of this really move us forward? Letâs look at the past 10 years. Incremental changes such as the ACA have expanded coverage to a degree, but failed to address costs. Republican proposals have sought to reduce costs, but would have resulted in further loss of coverage.
What has been virtually absent from any meaningful congressional discussion has been the concept of a single-payer, universal health insurance approach â what some call Medicare for All.
But with over 400,000 dead from COVID-19, millions either lacking insurance or with inadequate coverage, and costs that continue to spiral upward, consideration of universal coverage is long overdue.
As a physician for over 40 years, let me make this observation: Haven didnât fail because it was too bold and innovative. It failed because it wasnât bold enough.
Moving forward, it will take bold innovation by our Congress to address our twin dilemmas of cost and coverage. Medicare for All is our only reasonable path forward.
Or not. We can continue to just nibble incrementally around the edges of our health care crisis. But if we do, we should expect our results to be no different than those of Haven.
Dr. Donald R. Frey is professor of family medicine at Creighton Universityâs School of Medicine, and the author of âPay Me Now or Pay Me Later: One Physicianâs Guided Tour through an Insane Asylum called American Health Care.â This essay expresses his views alone and not those of Creighton University.