Center for Improving Value in Health Care
Jul 9, 2012 | 1 comments | Posted by Philip B. Kalin
Delivery System Redesign, Payment Reform, Rewarding Value, Court, Decision, Supreme, Controlling Costs
In grad school, our cigar chomping chairman of the department would explode with a resounding Horse Sh#@t whenever somebody gave an answer that wasn’t well thought out, supported by facts or was just plain wrong. Get it wrong on all three counts and his cigar would fly across the room at about the same speed as his expletive. It got your attention.
As I held my breath waiting for the Supreme Court decision, and fearing the Accountable Care Act (ACA) would be overturned, I reflected on the times when I could have responded with my professor’s epithet when facts were being ignored or willfully misconstrued. It wouldn’t have changed a thing but would have felt good for the moment.
Over the few days prior to the decision, I reflected on all the times I was so very “politically correct” in responding to criticisms of the ACA…despite knowing that they were not based in fact or were just pure politics. Instead, I would generally tiptoe my way into a response by acknowledging that the legislation wasn’t perfect, didn’t do enough to control costs etc…all before getting into the many things that the ACA gets right. After all, a fair analysis shows it’s fiscally responsible, a big boost to the private insurance market and most importantly, humane for nearly 30 million newly insured Americans. In an effort to uphold my non-partisan role as the CEO of a non-profit healthcare improvement organization, I fell into a trap of conflict avoidance - i.e. confusing non-partisanship with honest disagreement and being forthcoming with a straightforward recitation of what I know to be true after nearly 35 years of working in our broken healthcare system.
In a recent commencement address to the Medical and Dental graduating class at Harvard, Dr. Don Berwick, long time health reformer and former head of the Centers for Medicare and Medicaid Services, talked about this trap when he said, “I watched fear grow on both sides of the political aisle – fear of authentic questions, fear of reasoned debate, and fear of tomorrow morning’s headlines- fear that stifled the respectful, civil, shared inquiry upon which the health of democracy depends.” His description rang true for me and I’ve determined that I will speak more clearly about my view of the ACA and why I believe it is a huge step forward for the American people and a big support for free enterprise.
I am in favor of the Affordable Care Act. It dramatically expands health insurance coverage for 30 million Americans which is in itself the humane thing to do. But, it is also good business. Through insurance exchanges and other mechanisms it provides a huge boost to the U.S. private insurance market. (In Colorado alone, it is estimated that by 2016 nearly 75% of those uninsured who gain insurance will do it through the private insurance market, the remainder in Medicaid.) It also eliminates barriers to coverage for pre-existing conditions by upholding the notion that there shouldn’t be “free-riders” on our system who shift costs to those of us who pay for insurance. Lastly, the ACA aligns Medicare with the initiatives of many private payers in pushing for new innovations in how care is paid for and delivered. Ultimately, the ACA is the biggest boost for the private insurance market in history and, most importantly, according to the Congressional Budget Office, is fully paid for with a combination of tax increases and spending cuts elsewhere.
I do understand politics. But I also understand that, while the ACA has been made a highly inflamed partisan issue, its key elements are based on commonsense business thinking and traditional American values. In 2008, Colorado’s own bipartisan Blue Ribbon Commission for Health Care Reform came to the conclusion that it was good for business and Coloradans if we get everyone covered, change the system so that costs aren’t being pushed onto those who carry insurance, eliminate the many barriers to insurance coverage and sustain the private insurance market. As it happens, both of today’s current presidential candidates are running ads that agree with those same principles…it’s less an argument about what elements need to be fixed than who is sitting in the White House while it is done.
In Colorado we have been moving ahead on multiple fronts in the private sector with work that improves health and health care and controls costs—and which aligns with the ACA. Recent federal awards to Colorado projects implementing innovative approaches to care delivery and cost control reinforce what private sector Colorado is already doing. Similarly, the recent naming of Colorado as one of seven states to be a pilot site for a new primary care payment/delivery model for Medicare exactly aligns with the great work of private insurers and organizations for implementing highly successful care coordination models.
Colorado is emerging as a national leader for innovation and improvement. The Accountable Care Act puts wind into the sails of that important work and is both good business and good for Colorado. I for one am going to be saying that loud and often.
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