As Republicans in Washington get set to reshape national health-care policy, it is critical that the surrounding debate distinguishes between two related but distinct issues: access to coverage and access to care.
In other areas of policy, we understand this distinction. We know that the issues of homelessness and affordable housing are linked, but not the same. Solutions for one are not automatically fixes for the other. We see the same thing with other basic health issues like food security and nutrition.
Only in health care do we consider the decades-long challenge of delivering high-quality and cost-efficient care "solved" once everyone nominally has access to some sort of insurance.
But real health-care reform is not just about coverage. Getting people into exchange plans they can barely afford, with heavy (and increasing) deductibles and taxpayer-funded subsidies, is a "homeless shelter" fix. It's better than being on the streets — for sure — but a homeless shelter isn't a home any more than a high-deductible "bronze" plan is a real health-care solution for a family that can barely afford to pay the rest of its bills.
If we want to fix this system, it's time to get serious about replacing fee-for-service provider reimbursement with approaches that link costs to outcomes, like bundled payments and population health.