Posted on | October 10, 2013 | 2 Comments
Irrespective of the current stand-off, and posturing posing as debate, six years ago, in 2007, I wrote a piece that analyzed the Boeing Dreamliner project and asked the following questions:
“If you wanted to build a new health care system — a vehicle that would transport us to wellness, productivity, security and happiness — where would you begin? Would you work off of what we have now or build something brand new? Would you plan into the future? How far? Would you centralize planning or decentralize it? Would you outsource portions of the design, the financing, and the execution? Who would you listen to? Who would you build for? How would you measure success?”
Continuing, I noted that, “Even asking such questions about health care is exhausting. Our system is immense and complicated, and its problems seem insurmountable at times. 45 million uninsured, spiraling health care costs, a financing system that is broken, an explosion of chronic disease, demoralized physicians, frightened patients. It can all look pretty bleak. In the face of such daunting challenges, where does one find the energy and passion to even consider the notion of building something new? “
One year later, President Obama was elected and the nation was in economic turmoil which consumed enormous human, social and financial capital. All the more remarkable that, on March 23, 2010, President Obama signed the Affordable Care Act.
For the next two years, even as changes began to take place, the law became a political football. Republicans lined up as one against it, with their Presidential candidate promising to repeal it, and Republican governors challenging it in court. On July 5, 2012, Justice Roberts announced a Supreme Court decision upholding major elements of the law. Obama won the election, and here we are today.
Lost in the full-throated rhetoric (individual mandates, states rights, American exceptionalism) has been the transformative, comprehensive, and historic nature of this legislation. Most Americans have absorbed, at least in part, that the law will extend access to affordable health insurance while requiring citizens and employers to purchase coverage or pay a penalty.
While these elements are significant, what is arguably more remarkable is the extent to which the nation’s insurance industry is called to task for historic abuses that expanded corporate profits at the expense of American citizens. The law puts in place comprehensive health insurance reforms that will roll out over the next few years.
A quick listing of the major provisions helps capture the extent of this legislative action:
Rights and Protections
- Summary of Benefits and Coverage (SBC) and Uniform Glossary
- Consumer Assistance Program
- Appealing Health Plan Decisions
- Preventive Care
- Patient’s Bill of Rights
- Children’s Pre-Existing Conditions
- Doctor Choice & ER Access
- Grandfathered Health Plans
- Curbing Insurance Cancellations
- Pre-Existing Condition Insurance Plan (PCIP)
- Young Adult Coverage
- The Health Insurance Marketplace
- CO-OP Insurance Plans
- Value for Your Premium Dollar: 80/20 Rule and MLR
- Lifetime and Annual Limits
- Flexible Spending Account Changes
- Rate Review
65 or Older
- Medicare Preventive Services
- Medicare Drug Discounts
- $250 “Donut Hole” Rebate (2010)
- Strengthening Medicare
Of course, this is a work in progress. We face many challenges and unintended consequences ahead that, once revealed, will need to be addressed. At the same time, we need to confront short and long term financing of these programs, quality and reliability, and define better the responsibilities of the people and the people caring for the people.
Still, from this vantage point, I can not help but to feel optimistic that our President, and our government, in the middle of a debilitating financial crisis, marshaled the energy and the passion to reject the failing status quo of health care and lead positively, constructively and thoughtfully.
We now must do two things. First, we must see the transformation of the health care sector through, including the execution of an efficient, accessible and affordable delivery system with low variability and high reliability. Second, we must take this type of optimism and bold leadership and apply it to other sectors including financial, energy, education and transportation. If we can do that, it could be quite a positive and exceptional future for this still young nation.
For Health Commentary, I’m Mike Magee.