Health Care Reform: Let's Move On
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Now that the Supreme Court has ruled that the "individual mandate" in the Patient Protection-Affordable Care Act (PP-ACA) can be considered a tax and is constitutional, it is time for us all to move on and get about the business of improving health care delivery, financing, access and quality in America.
There are a number of provisions that were written into PP-ACA to obtain the necessary votes in a largely dysfunctional federal Congress. The underlying thrust of the law is to put patients and their care givers in charge of medical care and regulate the control exercised by third-party payment entities.
Our medical care payment system increasingly controls the patient/physician clinical relationship - government through Medicare and Medicaid, health insurers using careful policy definitions of what they will and will not pay for, aggressive use of our tort system, and a host of brokers, administrators and middlemen who add a percentage for their services. In the U.S., it is well-documented that Medicare and Medicaid lose in excess of $100 billion every year to outright fraud and abuse.
All contribute to the unsustainable cost increases that are restricting access for low-income families. The cost of care has increased so much in the past decade or two that even middle-income families are adversely affected.
Clearly, we must reform how we pay for health care in America. PP-ACA can help. It is based on using private insurance ownership. It is our best hope of avoiding government-controlled socialized medicine. At all costs, we must keep the patient/physician relationship away from control by the third-party money changers, be they government or private entities.
Both must be regulated to protect the public. We must move from a volume-based to a value-based payment system. Strengthening the patient/physician relationship is the only way to accomplish this reform. It is not time to repeal PP-ACA; it is time to fix parts of it!
Most of the provisions written into the law to get the votes necessary to have the law passed were vaguely enough written that enlightened regulations can correct them. Some fixes will require congressional action. Calling it a tax or a penalty is a complete distraction.
More people in the system must be paid for. America must stop spending borrowed money. The tax/penalty applies only to the people who should be paying for their care and choose not to be personally responsible for their care. On balance, there is much more that is good in PP-ACA than what needs fixing. We must move toward universal care that is paid for. America needs PP-ACA.
Another thing that the Supreme Court got right was its ruling on Medicaid expansion. The court ruled that it was unconstitutional to require states to lose their current Medicaid funding if they did not accept the expansion.
North Carolina and many other states cannot afford the expansion as presented. That the federal government would pay 100 percent at first is the same kind of kick-the-can policies that have gotten America into its sovereign debt crisis.
Yes, we need to move toward universal care. But let's fix health care financing first. One of the major problems in health care pricing is the massive medical manpower deficit we have developed in America.
It takes a lot of time and money to educate and train physicians. The supply/demand ratio has been going in the wrong direction for years. We must develop new ways to build integrated care teams and use the power of electronic information technology to make medical care delivery more productive. All of this will require leadership. It will not be easy.
The Pilot's readers are fortunate to be living in the Sandhills area. We have an excellent medical care community and a wonderful hospital. The leadership of Community Care of the Sandhills (CCS), FirstHealth of the Carolinas (FHC) and Mid-Carolina Physicians Organization (MCPO) are all hard at work building an integrated, patient-centered health care delivery system. For the first time in my medical care life, I believe they will succeed.
We all must become involved in this health care revolution. Patients, care givers, physicians, hospitals, insurers, third parties, businesses and the public must all sign on. This Fourth of July season is a good time to renew our commitment to revolution!
H. David Bruton, M.D., is a retired pediatrician. A former member of the Moore County Board of Education, he served during the 1970s as chairman of the N.C. State Board of Education. From 1997 to 2001, he was secretary of the N.C. Department of Health and Human Services. He is the founding chairman and board member of the Moore Free Care Clinic.
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Comments
MikeNC 10 months, 3 weeks ago
The PP-ACA is a law and manual of directions with 2,700 pages. Now how is something to be fixed, when no one to date has read all the directions? This law is going to evolve over a 5 year time span. Certain articles of it already in place. What is unknown is as new regulations and taxes come into existence, that are tied to articles of the law that will be implemented further down the line, how are you going to eliminate the "bad articles" if they are tied directly, or indirectly into the articles, approved of? The arguement before the Supreme court on this law, is a perfect example. One portion of this law was the mandate. So important was this mandate or one article of the bill, that is struck down, the chances of the whole law substaining, was all most impossible. Diane
dustyrhoades 10 months, 3 weeks ago
I'm with you, Doctor, but the Right's still trying to re-litigate the Civil Rights Act. They don't ever "just move on." Hopefully the country will "move on" from them as age winnows their ranks.
kzowens 10 months, 3 weeks ago
Amen, Dr. Bruton!!! As I understand it, Mr. Romney championed much the same act when he was Governor. How can he take the stand he is taking?
dustyrhoades 10 months, 3 weeks ago
How can he take the stand he is taking?
Because he's a soulless lying weasel who'll say anything to get elected, even if that contradicted what he just said literally hours before.
http://www.stltoday.com/news/opinion/columns/the-platform/editorial-mr-romney-s-temporary-sanity-results-in-fastest-flip/article_4024681a-2570-54a1-9ced-988a4d98de89.html
JD 10 months, 3 weeks ago
we must keep the patient/physician relationship away from control by the third-party money changers, be they government or private entities.
Quoted for truth. Thank you Doctor. I am glad someone in the field is speaking from a professional back ground on the health care situation.
How can he (Romney) take the stand he is taking?
Because he panders to an ignorant base and says what he thinks they want to hear. Even though he was for it, now against it, and probably be for it again when he can't have it repealed even if elected. Remember Romney is a career politician that will do what he can to buy, lie, and cheat his way to the office. Or worse,not be treated like the John Kerry of the Republican party.
fugitiveguy 10 months, 3 weeks ago
" They don't ever "just move on."
thats rich coming from the party that still periodically moans about the 2000 election being "stolen"
fugitiveguy 10 months, 3 weeks ago
"The PP-ACA is a law and manual of directions with 2,700 pages."
that in itself is boggling. I'm all for healthcare reform, this ain't it.
fugitiveguy 10 months, 3 weeks ago
What effect will the ACA have on the ballooning national debt? I mean I know we don't like to talk about that on here, esp because Obama promised to "cut it in half" if I'm not mistaken. If Obama was a republican we'd get a tin ear from the lefts chants "Obama lied, Obama lied" Not even a peep about this from the acolytes.
dustyrhoades 10 months, 3 weeks ago
The CBO projects it will cut the deficit. This has been noted numerous times.
https://docs.google.com/viewer?url=http%3A%2F%2Fwww.urban.org%2Fuploadedpdf%2F412182-health-reform-deficit.pdf
Bentpan 10 months, 3 weeks ago
dustyrhoades 1 hour, 56 minutes ago The CBO projects it will cut the deficit. This has been noted numerous times. Why does Mr Rhoades say this, Well ,"Because he's a soulless lying weasel who'll say anything" to push liberal Progressive agendas. The last CBO numbers had its cost at 1.7 Trillion dollars and thats after defunding Medicare of $500 Billion to support it and this when our baby boomers are about to put medicare under additional pressure with a huge influx of addional recipients. Is it constitutional, the supreme court says so, is it a good or even a sensible law, almost 70% of Americans say it isn't. Fortunately alot of Liberal Democrats including this president are to see the end of their political careers this Nov. and in Jan 2013 we'll see the end of Obamacare
Bentpan 10 months, 3 weeks ago
WilliamFBuckley 7 minutes ago And as long as we're doing the whole DEMONRATS vs REPUBLICANTS thing, don't Republicans want to defund Medicare entirely to begin with?
Nope, thats never been suggested even once by a republican, That was a liberal lie tossed out when the Republican congress tried to pass a legitimate federal budget which we still don't have after 3 1/2 years because of this president and his obstructionist spendthrift party, And yes stripping Medicare of 1/2 trillion dollars when they are facing increased enrollment is to defund; as in to deplete the financial resources of
JimHeim 10 months, 3 weeks ago
Bentpan, you are just a font of misinformation. As for the $500 billion Medicare figure; that's not for reducing Medicare benefits. it's what we save by eliminating Medicare Advantage, an experiment in allowing private enterprise to provide Medicare. It wastes ninety-three cents on the dollar. Are conservatives in favor of government waste now?
I'm delighted that Congress saw the advantage of saving this money. Why aren't you?
fugitiveguy 10 months, 3 weeks ago
I know this is trivial to my liberal friends. Has any government projection for what something costs ever come close to being accurate? I guess it doesn't matter when the only limit on how much you can spend is your supply of paper and ink.
Bentpan 10 months, 2 weeks ago
JimHeim 2 hours, 51 minutes ago Since you obviously know I regard you to be a pathological liar why would you think for one moment I or in fact, any reasonably intelligent person would give one iota of credence to any of your posts.
JimHeim 10 months, 2 weeks ago
Bentpan, your inchoate rage and lack of knowledge are a sad combination. Seek help.
uscdad1977 10 months, 2 weeks ago
With an apology for this lengthy sentence, PPACA is such a great solution that Congress has exempted itself from obeying it, the vast majority of Americans see it as an infringement on personal freedom, the CBO has retreated from its original cost projections and increased the projection dramatically and our lawmakers are still trying to understand a law they "had to pass to see what was in it." We have yet to hear what the cost to taxpayers (the half or so who actually pay federal taxes now) will be to fund the salaries, benefits and pensions of the tens of thousands of new federal employees we will be paying for over the coming decades Stockton, CA, anyone?) As for any promises of cost cutting, please cite for me one successful landmark federal program that actually came down in cost over its lifetime. We have been sold a pig in a poke once again. By the way, at 63, I and my employers over the years have been paying into (i.e., loaning the feds) money for Social Security and Medicare, so how do these programs constitute an "entitlement?"
JimHeim 10 months, 2 weeks ago
Okay all of you health care experts, here's your chance to step up and solve the problem.
An article in the Wall Street Journal a couple of days ago pointed out that "10% of Medicare beneficiaries who received hospital care accounted for 64% of the program's hospital spending."
How would you contain costs in such an environment?
Bear in mind that within eight years, the cost of health insurance will exceed the average family's mortgage. Company-paid health care will require very high co-pays or policies will be dropped altogether. How will you prevent the continuing catastrophic rise in health care costs?
nothingspecial 10 months, 2 weeks ago
There were all kinds of plans proposed by the Republicans that would have solved the problem at a fraction of the cost. Such as this one.
http://online.wsj.com/article/SB124277551107536875.html
And by the way, the folks who designed the ACA were obviously not experts either.
teufelhunden 10 months, 2 weeks ago
Conveniently, many of the tentacled arms of this monster dubbed ObamaCare will not strangle the majority of Americans until about 2013-after the election. So yeah certain people want us to "move on"...nothing to see here folks...
teufelhunden 10 months, 2 weeks ago
The taxman cometh...
Bflat 10 months, 2 weeks ago
Bruton says, " The Pilot's readers are fortunate to be living in the Sandhills area. We have an excellent medical care community and a wonderful hospital." That's his opinion, but many people leave the area and go to UNC Hosp or Duke instead.
JimHeim 10 months, 2 weeks ago
nothingspecial, The ACA is a Republican creation. Designed by the Heritage Foundation, endorsed at the time by such Republican luminaries as Newt Gingrich, and passed into law by the Republican governor of Massachusetts - you know, Mitt Romney.
How come your side turned on it?
cooldaddy 10 months, 2 weeks ago
The new heart center is excellent. The hospital itself in Pinehurst is, at best, ok. Let Universial healthcare, (remember that term), take place and we will drool for what we have now. There is a lot lacking for sure, but competition would assure quality. Now we are entering a low quality service era.
SH59 10 months, 2 weeks ago
From the Washington Post: People are entitled to their opinions, but not to their own facts. And the facts in this case are clear: Since the Affordable Care Act was passed, national health spending is rising at a slower rate, health insurance premiums are rising at a slower rate, small-business coverage is holding steady and Medicare is on a stronger financial footing.http://www.washingtonpost.com/opinions/kathleen-sebelius-the-affordable-care-act-has-made-the-us-health-care-system-stronger/2012/07/09/gJQA1BOOZW_story.html?wpisrc=nl_opinions
Toda 10 months, 2 weeks ago
"but many people leave the area and go to UNC Hosp or Duke instead."
Toda 10 months, 2 weeks ago
Another note of interest as well Bflat ~ schedulers will schedule several appointments in one day to avoid driving to hospital or clinics several times in one week. I've personally found that even though First Health is convenient ( 5 minutes away), some procedures are overbooked which is usually the case for endoscopic procedures. I can drive to Chapel Hill in about the same amount of time it takes to be seen at FH and clinics.
Bflat 10 months, 2 weeks ago
I add that the billing system at First Health ranks at the bottom of the totem pole when they don't file all insurance, file the wrong 2nd and Tertiary, then mistakenly turn over to collections that wrongfully damage credit. This takes forever to correct with many letters, online account comments, and emails. That kind of stress is not needed . They need a better system. Imagine the nightmare of the future when the "Reformed Health care" comes into effect.