This Train is Leaving the Station

healthcare reformMy Comments: First, I’ve been a supporter of Obamacare since day one. Not because its a panacea for what ails us, but because without it, none of the stakeholders individually have enough leverage to effect meaningful change. By that I mean, doctors, hospitals, insurance companies, Big Pharma, and of course, patients like you and me. The only path to reform is a force with enough leverage so that those above mentioned stakeholders are forced to adapt.

I’ve also asserted that what we see ten years down the road will not resemble the PPACA as passed in any meaningful way. Implementation will force adjustments as unintended consequences surface and everyone tries to stake their claim to a legitimate piece of the action.

I’m also reminded of comments made in a recent Time magazine feature that focused on a new way unfolding to combat cancer. Egos are being squashed in the interest of team work and continued funding is a function of actionable and positive results, not how many scientific papers are published. It was said to be totally unworkable, until it became workable and there is no going back. What took ten years to get from idea to those with cancer now takes two years.

By Jim Toedtman

Mention health care costs, and Mark McClellan talks about train tracks.

Few people know more about the dynamics and details of the nation’s health care system than McClellan, the former director of the Food and Drug Administration and then the Centers for Medicare and Medicaid Services. One set of tracks, he says, carries the current train – with doctors, hospitals, insurance and pharmaceutical companies organized around paying for specific tasks performed.

What we must do, he continues, is construct a second set of tracks where health care is provided by teams delivering comprehensive care, where doctor’s payments are determined by the results, where digital records are widely shared and where costs are mitigated by a vastly expanded pool of people with insurance.

This is the heart of the health care reform that was approved by Congress, was affirmed by the courts and is being implemented this year.

We have a health care system that consumes 17 percent of the national economy and is unsustaintable if it follows the current tracks.

Today, new tracks are being built, complete with a set of guideposts, a checklist of both critical questions and potential milestones.

Will companies cover their workers? Employer-provided health insurance remains the linchpin of the nation’s health care system, covering nearly 60% of those under 65. But in a sluggish economy, companies may be tempted to curtail coverage.

Will the unisured enroll? This is really the heart of the effort. The 21 million 25 – 30 year olds must enroll, even though they may consider health insurance unnecessary, because their enrollment will help finance the system. Of the total 56 million now uninsured, the Congressional Budget Office projects 25 million will enroll by 2020. Those who delay enrollment face taxes that escalate as the years pass.

Is there adequate staff? Meeting the medical needs of the new enrollees will stretch the nation’s already thin workforce. A shortage of 91,500 doctors and 1.2 millin nurses is projected by 2020.

Are the state insurance marketplaces set? And are their base insurance policies affordable?

Patients, finally, have a critical role in helping refocus our system on results rather than the number of services provided, on individualized and preventive care rather than automatically utilizing the latest gadgets and technology.

As patients, we must engage and begin persuing smart health steps that prevent chronic disease. Attention stakeholders! All aboard!