Health Care Reform: Let's Move On
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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