Grace-Marie Turner: How to advocate for enlightened healthcare policy  

March 29, 2024 3:47 pm

Managing the finances of our nation’s hospitals and health systems is a task whose complexity is little understood by those outside the profession. Beyond being adept at managing complex healthcare financial matters, leaders also must focus intently on ensuring their organizations are delivering high-quality, cost-effective care.

In addition to this knowledge and skill, finance leaders also must understand and integrate larger factors into their decisions, including the machinations of Washington policymaking. If you are baffled by the impact of government healthcare policy on your work, you are not alone.

I hope to be a translator for you, based on my experience first as a journalist and then, for nearly 30 years, as leader of the Galen Institute. My work has taught me an important lesson: To impact our nation’s complex labyrinth of healthcare policy, leaders must be guided by core principles. And I know HFMA shares that goal as it tracks policy developments affecting its members while looking to advance positive changes.

To begin to simplify the complex, we must consider two factors:

  • The forces that drive policy
  • The ideas that motivate those of us who share a fundamental belief in the importance of innovation and competition

Impact of high healthcare spend

In 2022, U.S. spending in the healthcare sector approached $4.5 trillion.a Half of that was paid by taxpayers to finance care delivered through Medicaid, Medicare, the Affordable Care Act, the Children’s Health Insurance Program, state programs and more. As the work of Wharton School Professor Emeritus Mark Pauly has shown, most of the rest of the private healthcare sector also is controlled indirectly by government through mandates and directives “not leaving much in the unfettered, market-based category.”b

Despite this government involvement, most people in the United States still have private health coverage that they value and want to preserve.c

The extraordinary burden on federal and state taxpayers to finance the public share of our complex healthcare system presents a real risk of government insolvency or crushing tax increases.d It’s clear that government-centric programs are running out of other people’s money. More and deeper payment cuts in public programs shift more healthcare costs to private payers. Changes in policy are vital; we can’t leave the system on autopilot.

It is up to us in the policy community to offer recommendations for responsible changes that will protect programs that people rely on and provide access to care for the most vulnerable.

Other important motivators for U.S. healthcare policy

There is a suffocating amount of minutia in healthcare — legislative details and regulations that require armies of accountants and lawyers to decipher. But there are big issues involved here around ideas of freedom, government solvency and the role of government in our lives.

Without freedom over healthcare, others literally control our lives. We all have had experiences where we had to drop everything when our health or the health of a loved one was threatened. When that happens, who do you want to make the decision about the needed care, you or the government? That’s the ultimate question. If the government controls all of the financing, it will also control the choices available to us.

It is up to policy advocates to recommend new ways to give people better choices and provide incentives for healthcare entities to put patients first instead of responding to government directives that may subordinate patient needs.

A guiding premise: defend innovation and personal choice

Patients have a vested interest in the outcome of our policy fight, yet too many feel like they are only cogs in the system — billable cogs with little or no power to control decisions about their care or coverage.

Reengineering U.S. healthcare so decisions are centralized in Washington, as some are proposing, will suffocate innovation and deter personal choice. Simply put, there are many fundamental reasons for removing regulatory barriers, including:

  • Paving the way for innovators
  • Giving new incentives to states to approve a broader array of health plans with the benefits people choose
  • Strengthening the safety net

We need bottom-up reform that gives to physicians and hospitals and insurers and pharmacies and drugmakers — everyone in the healthcare sector — incentives to innovate and better respond to the need of patients for lower-cost, higher-quality care.

It comes down to clearly focused advocacy that recognizes what’s at stake. We need to free human ingenuity by loosening the straitjacket of federal rules and mandates to encourage innovation and engage private-sector energy, enabling a competitive market that is centered on the patient to provide better, more attractive and affordable options.

Innovation determines the possibilities

Dazzling advances in medical technology promise to transform medical care. Imagine an integrated device that includes an insulin pump, a glucometer and software to use photos from a smartphone that counts carbs and doses insulin.e And that is just a hint of what’s possible.

And the potential has barely been tapped with AI in the healthcare sector to target the best treatments to much-better-informed patients, with the promise of eliminating a great deal of the inefficient, duplicative care. By avoiding unnecessary tests and treatments, the nation’s healthcare dollars will go further and avoid the Draconian cuts that could otherwise be imposed.

Much-needed modernizations in public policy would have companies see patients and not government payers as their customers. Patients would have more choices of care and coverage that meet their needs — with incentives to seek the best value. And tapping into AI’s potential can enable us to target resources on safety-net programs to better ensure the most vulnerable have access to the best care. 


a. CMS.gov, NHE fact sheet, page last modified Dec. 12, 2023.
b. Pauly, M.V., Will health care’s immediate future look a lot like the recent past? American Enterprise Institute, June 2019.
c. Keisler-Starkey, K., Bunch, L.N., and Lindstrom, R.A., Health Insurance Coverage in the United States: 2022, United States Census Bureau, September 2023.
d. For a discussion of this risk, see Brill, A., The negative economic effects of Medicare buy-in and public option proposals, report sponsored by the U.S. Chamber of Commerce, August 2020.
e. Cho, T., Gowda, V., Schulzrinne, H., and Miller, B.J., “Integrated devices: A new regulatory pathway to promote revolutionary innovation,” The Millbank Quarterly, Jan. 22, 2024.


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