5 things I'm thankful for--but could still be better

With Thanksgiving and the holiday season upon us, there are lots of changes going on in the healthcare arena that I'm thankful for. Since this is not a perfect world, things can be better. Here's a list of changes I'm thankful for, but where there remains significant room for improvement.

1. I am thankful for the fact that despite its often deep flaws, America is moving toward a working healthcare system that insures millions of more people than it did a year ago and millions more in 2015. And I am not only thankful that health insurance for my family costs significantly less than it did in 2012, but astonishingly enough, our 2015 premiums will be about 6 percent lower.

But I would be more thankful if:

This country actually had a debate about the best way to approach healthcare reform. Instead, it's been a mostly snarling shout fest, often woefully short on facts, and those being presented more often than not are distorted. More recently, the discourse on healthcare reform has devolved into a series of shallow "gotcha" memes, whether it's "if you like your insurance, you can keep your insurance," or the "stupidity of the American voter."

The public already is woefully underinformed on a variety of topics. The discourse on the Affordable Care Act (ACA) to date only serves to ensure that they remain that way, and will likely impede improvements to the ACA in the future.

2. I am thankful for the fact that Pennsylvania has decided to expand its Medicaid program, and that Utah and Iowa are debating expanding their programs.

But I would be more thankful if:

Expanded Medicaid expansion was the law of the land and that the entire Deep South decided that it was worth making sure their poorest residents had better access to healthcare services.

3. I am thankful that the drugs Sovaldi and Harvoni have been introduced and are proving overwhelmingly effective in curing hepatitis C, which infects 170,000 Americans every year, kills 9,500 annually and normally requires a liver transplant to retard its progression.

But I would be more thankful if:

There had been more transparency and less apparent cynicism regarding the prices set by Gilead for its two miracle drugs: $1,000 a pill, or $84,000 to $94,500 for a regimen. Steven Brill asked a key question about this back in June: "Why the folks at Gilead didn't feel enough of a sense of accountability or sensitivity to public reaction to decide to charge, say, $989 or $1,023. That would have at least given the impression that in calculating the price they did something other than ask 'Why not?'"

Moreover, those sky-high prices are putting huge pressures on state Medicaid programs to pick and choose who is going to get the potentially lifesaving medicine. Given that hepatitis C afflicts the poor and African-Americans far out of proportion to their actual numbers in this country, it suggests that healthcare rationing is acceptable for those groups (although an apparent outrage for everyone else).

4. I am thankful that there are companies like Castlight, Healthcare Bluebook and others that are putting in significant efforts toward price transparency in the delivery of medical services.

But I would be more thankful if:

Providers, insurers and even state agencies would be more willing to treat price transparency as a necessity in a time when consumer-driven healthcare is pushing toward reality. And every time a hospital lobby says they're in favor of transparency that you can see through or there is organized resistance against all-claims databases or other necessary tools, the consumers themselves are informed enough to push back.

5. I am thankful that I will be attending a Thanksgiving dinner where there will be an abundance of food.

But I would be more thankful if:

A large proportion of the country did not eat like it was Thanksgiving practically every day of the year, driving up rates of obesity and chronic diseases and ultimately healthcare costs for everyone.

Happy Thanksgiving to you all. - Ron (@FierceHealth)