It has been a week since the Patient Protection and Affordable Care Act - better known as the health care reform bill - was signed into law by President Obama. The political debate goes on and will likely continue through this year's election season, as elected officials and voters debate the law and its effects.
Apart from the political debate, we wanted to know what was next for the nation's health care system. So we turned to Tom Lee, who's CEO of Partners Health Care in Boston and coauthor with James Mongan of Chaos & Organization in Health Care, which analyzes the prospects of reform from the standpoint of the delivery of care. He sent us the following thoughts on the changes just enacted, the challenges that lie ahead, and why reform matters.
The second type of reform is payment reform – i.e., how providers are paid. Will they continue to be paid fee-for-service, by the test, by the procedure? Or will the funds made available through the new legislation be used in some different way, such as bundled payments for episodes of care or capitated payments to providers for care for an entire population?
If the payment system does not change, we can expect slow progress on the third and most important type of reform – delivery system reform. Delivery system reform means real change in the way care is delivered. It means providers getting more organized, and implementing systems that make care more efficient and higher quality.
Ultimately, delivery system reform is the real goal – it is the end, for which payment reform is just the means. It is our best hope for truly improving the efficiency and quality of care.
A reasonable question is – why weren’t all these issues addressed together? The reason is that it is too complicated. Meaningful efforts to change the payment system and the delivery system would create too many losers who would do their best to sabotage the change.
I strongly believe that the way we took on health care reform in Massachusetts makes sense – first get everyone covered, then take on costs and other tough issues. Once you have everyone covered, then the gun is held to our heads to get down to the ugly work of changing how we do things in health care. If you don’t have that commitment to full coverage in place, then it is all too easy to squirm out of short term financial challenges by un-insuring or under-insuring people.
I hope we really do have a much broader national commitment to covering most Americans now. And I know that the challenges in making that commitment work will be brutal. But for the faint of heart, let me give one glimpse of the reward within our reach.
In my practice at the teaching clinic at Brigham and Women’s Hospital, my population is very mixed socioeconomically, racially, and medically – but they are all alike in one way. Every single patient now has insurance. My last uninsured patient got coverage last fall through the Massachusetts Connector. He is a 62 year old self-employed electrician with diabetes. He really needs insurance, and it is a lot easier for me to take care of him now.
That’s why slogging away at the second and third types of health care reform is work worth doing.