Mr. Toad’s Wild Ride as a Metaphor for Healthcare Policy Making and Legislation by US Lawmakers

By Cora Butler, President and CEO, HealthCore Value Advisors 

Anyone visiting California’s Disneyland Park since July 1955 or the Magic Kingdom at Walt Disney World in Florida between October 1, 1971 and September 7, 1998, may have experienced an attraction known as Mr. Toad’s Wild Ride.  This ride belongs to a genre of ride-through attractions known as “dark rides” that use various techniques such as lighting, sound, and animation to create illusions.

Although not on the list of the “25 best theme park dark rides in the world” published October 19, 2015, by the Los Angeles Times, Mr. Toad’s Wild Ride seems like a particularly apt analogy for the political machinations surrounding efforts to “repeal and replace” what is commonly known as Obamacare or The Affordable Care Act.

Mr. Toad’s Wild Ride, Magic Kingdom version, has been described as having passengers’ experience sudden turns while the “jalopies” in which they are riding made sudden turns moving at full speed toward an impediment giving the appearance of an imminent collision when suddenly, at the last second, the obstacle moves out of the way. (Wikipedia contributors. “Mr. Toad’s Wild Ride.” Wikipedia, The Free Encyclopedia. Wikipedia, The Free Encyclopedia, 26 October 2017. Web. 26 October 2017.) I would argue that description has much in common with what we have experienced in this country in health care policy making and legislation since January 20, 2017.

A USA Today headline on September 25, 2017, read as follows: “Sen. Susan Collins says ‘no’ to Graham-Cassidy bill, essentially killing Obamacare repeal”.  Senators Graham and Cassidy once again were featured in a USA Today article published October 19, 2017, titled “Lindsey Graham and Bill Cassidy boost bipartisan Senate effort for short-term Obamacare fix”.  This just a week after Trump signed an Executive Order ending what he describes as “illegal subsidies to insurers”, essentially declaring in a veritable storm of Tweets that since Congress couldn’t get the job done he would personally take care of the problem himself. Every day brings a new flurry of headlines, with today, October 26, 2017, being no exception.

Effective March 23, 2010, The Affordable Care Act (ACA), initially labeled as Obamacare as a pejorative but now as common parlance, was touted as having three core goals: improving quality of care; improving the health of those patient populations with common (and expensive) chronic diseases and reducing the cost of care across the board.  So how did a law with such laudable sounding goals become the flash point for such a firestorm?

According to Sean Williams, an economist specializing in the healthcare sector, writing for The Motley Fool, in an April 8, 2017, article titled “Obamacare: We Hate It, Love It, and Don’t Really Have a Clue What It Does” the reason(s) can be summarized for the current difficulty with The ACA and healthcare reform by saying:

  • We hate that Obamacare forces us to buy health insurance and penalizes us if we don’t.
  • We love that it’s allowing low- and middle-income folks, and those with pre-existing conditions an opportunity to be covered.
  • And we really don’t understand how health insurance works in the first place.

The more likely reality turns out that for a significant portion of the population the answer may be that it is all three.  An additional truth that providers are keenly aware of is that healthcare policy and law are on a fast track for continued change creating a need to understand, to the degree possible, the current landscape and the potential impact to providers across the continuum of care.

Providers, although caught in a veritable firestorm of change, cannot just stop, and wait for the fire to sweep over them if they expect to survive.  It is, therefore, incumbent upon providers and their administrators to turn data into actionable key metrics to guide practice management decisions so that even though Mr. Toad’s Wild Ride continues in Washington DC practices have a strategy for surviving (and thriving) despite the storm swirling around them.