Current US health policy and the future of person-centered care

Abstract

Current US health policy is contested and consensual. This is not new to American healthcare, as the last 70 years have seen on the one hand conflict between those who would expand access to health services and those who would restrict it and, on the other, a popular pursuit of biomedical research and the interventions it spawns. During the last year, US health policy has repeated this dynamic, with multiple unsuccessful attempts to repeal the Affordable Care Act (ACA) as well as (near) unanimous passage of the 21st Century Cures Act. This paper reports on each half of the conflict-consensus dynamic and considers which, if any, aspects of these current US health policies might lead to more (or less) person-centered care. Attention will be drawn especially to access to healthcare under the ACA and the use of “real-world evidence” under the Cures Act. The former allows more Americans to receive more of the care they need. The latter challenges evidence-based medicine’s evidence hierarchy, where randomized controlled trials (RCTs) are considered superior to other ways of knowing, even for the care of individual persons. The paper describes the current discussion of what sorts of evidence are appropriate to a drug and device regulatory regime. It remarks on the claims to person-centeredness by proponents and opponents of both bills and on potential dilemmas posed when aspects of person-centeredness conflict.