Manan Trivedi, the Democratic challenger to five-term US Representative Jim Gerlach (PA-6), is unique among critics of America’s healthcare system: he's actually worked in healthcare.

But while the primary care physician says the Affordable Care Act didn’t go nearly far enough in its efforts to curb the rising cost of medicine, he saves his sharpest critique for the reform proposals state and national Republicans have recently rallied around.

“I want to preserve Medicare. I don’t want to turn it into a voucher program, which, frankly, is [the Republican’s] plan,” Trivedi, 38, told Patch after addressing a group of protesters outside vice presidential candidate, and Path to Prosperity architect, Paul Ryan’s August 21 rally in West Chester.

“Healthcare is going eat up the budget, but the answer is not to shift costs to seniors. You’re just putting the burden onto the weakest, the most vulnerable, the oldest members of society.”

Targeting Waste

With the nation's healthcare tab almost doubling in the last decade, exploding public and private budgets alike, Trivedi proposes a different tack for tackling the problem: rather than shift the burden, he argues, we should reduce it.

“Most experts agree that 30 percent of everything they do in healthcare is useless,” he said. “It’s expenses that don’t make a lick of difference in your final outcome. There are unnecessary tests, unnecessary procedures, and non-indicated prescriptions and diagnostics.”

“We don’t have to bring that 30 percent to zero,” he went on, “but cut five percent of that, five percent of a two-trillion dollar industry, and that’s your cost savings right there.“

More robust comparative effectiveness research, he's confident, can help us find that five percent.

According to Trivedi, the industry is “sitting on mountains of data” right now—with, thanks to greater electric medical records and an advancing science of “biostats,” even more information on the way—that can point us towards smarter ways to manage illness. But because of what he calls the fragmentation of the system—insufficient communication between physicians and insurance companies; each provider an island—this treasure trove of money, and life, saving facts is going unused.

“Take, for example, low back pain,” he offered. “If you have low back pain right now you can go to five different doctors and get five very different treatment plans. One doctor says stretch and take some Advil and call me in two weeks. The doctor on the other side says lets do an MRI today and do surgery next week.”

Which one is right? Trivedi says the problem is that we don’t know—but we could.

The Problem with ObamaCare

When reminded that the Affordable Care Act established a framework for enabling these very sorts of comparisons, Trivedi—who was a healthcare advisor for Obama’s campaign before he first ran for Congress in 2010—blanched: while the AFA took tremendous steps to expand coverage, he said it simply won't contain cost. 

And if these costs continue to rise unchecked, he added, even this coverage expansion will be impossible to implement.

“There are small pilot programs,” he admitted,  “but that’s not nearly going to put a dent in the problem.”

But neither, he said, will Republican plans to make the system more market-based.

If Ryan supporters have their policy druthers, he warned of a “death spiral”: the healthy and wealthy would do fine, but the poor and sick would skimp on medicine and preventive care and end up requiring more expensive emergency treatment later.

“It’s health economics 101,” he said.

But while he concedes there’s some merit to a free enterprise approach, he says there's a glaring flaw in any plan that's premised on patients making sound judgments about which medical services to buy: most patients don’t know anything about medicine.

“The market doesn’t work in healthcare when people are making less than informed choices,” he said.