It’s Time to Focus on Real Healthcare Reform

Affordable Care Act needs effective fixes, not more "repeal and replace" efforts


By Toby Cosgrove, M.D.

Cleveland Clinic president and CEO

Now that the latest effort to “repeal and replace” the Affordable Care Act has failed, it’s time to propose real fixes to the federal law that will actually improve healthcare for all Americans.

My hope is that Congress can now undertake a sober, bipartisan analysis of the ACA, maintaining what works and fixing what doesn’t.

According to a recent Kaiser Family Foundation poll, nearly 70 percent of Americans want Congress to fix the ACA by stabilizing the insurance market. At a minimum, legislation should do just that, while maintaining the ACA’s successes – widespread insurance coverage for Americans, guaranteed coverage for those with pre-existing conditions, and affordable access to coverage and care.

However, the ACA has failed in its aim to slow escalating healthcare costs. Until we control costs, paying for healthcare will continue to be problematic and contentious.

It won’t be easy, though. Bending the cost curve in healthcare is something with which every developed country is struggling.  It isn’t going to be achieved by any one law, reform or sector. Caring for a growing and aging population will require sustained effort and cooperation between providers, payers, politicians, drug and device manufacturers, civic leaders, the business community and the general public. In other words, everyone.

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To start, I suggest focusing our efforts in three key areas – making healthcare delivery more efficient, bringing down pharmaceutical costs, and improving Americans’ health and wellness.


  • Reduce regulatory barriers: In recent years, the federal government has increasingly tied payments to compliance with well-intentioned regulations. Unfortunately, the number and complexity of these regulations has led to physicians facing their computer screens more than their patients, while adding unnecessary costs.
  • Allow hospital mergers: Another way to improve efficiency is through mergers, which create an economy of scale and simplify a health system’s ability to work across the care continuum, such as hospitals to long-term health facilities or home health. In many cases, however, the Federal Trade Commission opposes hospital consolidations.
  • Encourage new delivery options: healthcare is no longer delivered only in hospitals and doctor’s offices. Increasingly, healthcare is being delivered in retail locations and at home, via telehealth and smartphones. However, long-term success will rely on more payers – including our government payers – to reimburse for these new delivery methods, such as telehealth and smartphones.

Drug costs

  • Lowering pharmaceutical costs: The cost of medications is rising 10 percent annually. Practical steps – such as use of value frameworks, streamlining the process for approval of generic drugs, group purchasing, and negotiating collaboratives – can help to keep prices under control without inhibiting free market competition. But it’s also time to look at common sense regulations to rein in price-gouging behavior on the part of some manufacturers.

Better health for all Americans

  • Wellness and chronic conditions: Ultimately, the best way to lower healthcare costs is to keep people well. However, 16 percent of Americans continue to smoke; one-third are obese; and more that 62,000 are projected to die due to opioid addiction this year. This brings with it steep economic costs – obesity costs an estimated $147 billion annually, smoking $300 billion, and opioid addiction $78.5 billion.
  • Decreasing obesity and smoking by just 10 percent could result in more than $20 billion annually in direct healthcare cost savings.
  • Changing people’s behaviors will require a new approach, such as modest, but meaningful, financial incentives. Decreased co-pays or small financial bonuses for healthy behavior – such as weight control, managing chronic conditions, keeping preventive care appointments or smoking cessation – has been shown to motivate patients to manage their own health behaviors.

We know these incentives work because we’ve seen them work firsthand here at Cleveland Clinic. Direct incentive programs have drastically reduced the costs to care for the 100,000-plus members of our Employee Health Plan.

So, to Congress, I ask: Please don’t launch further “repeal and replace” efforts. Instead, work across the aisle, transparently and publicly, to sustain a high-quality American healthcare system through efficiency, accessibility, affordability and wellness.

About Cleveland Clinic

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 51,000 employees are more than 3,500 full-time salaried physicians and researchers and 14,000 nurses, representing 140 medical specialties and subspecialties. Cleveland Clinic’s health system includes a 165-acre main campus near downtown Cleveland, 10 regional hospitals, more than 150 northern Ohio outpatient locations – including 18 full-service family health centers and three health and wellness centers – and locations in Weston, Fla.; Las Vegas, Nev.; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2016, there were 7.1 million outpatient visits, 161,674 hospital admissions and 207,610 surgical cases throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries. Visit us at Follow us at News and resources available at