Healthcare Reform (well, at least Insurance Reform)

The Change Doctor Blog has to comment on this important moment in our country's history... On Sunday night, the House passed “The Patient Protection and Affordable Care Act,” a landmark health care reform bill. This legislation, along with a crucial package of specific improvements, aims to lower costs and expand access to millions of Americans. It's been a long road, but the echo of "Yes, We Can!" rings a bit louder this week.

While it is not ideal, we are at least closer to reaching what I believe is both an ethical and financial imperative in making healthcare insurance affordable to every American. A good summary of this bill is found in this MarketWatch article. Also check out: http://www.healthreform.gov

But let's not kid ourselves- the race is far from over. We need to realize that this is just "Insurance Reform", meaning that it makes insurance companies act as they should act: like risk pools who do not get to cherry pick who is in their pool (i.e. no more exclusions based on past history). At the same time, it makes the game fair for insurers by pushing everyone to get insurance - thus making sure that young, healthy adults don't get to completely opt out of the system. There are nuances, but that is the core part of what is happening - and it will take a few years to get into full effect.

What this does NOT do is stop the spiraling cost of healthcare related to increasing illnesses, tests and treatments... in a system that predominately rewards Volume over Value. In other words, the second part of this movie is "Reimbursement Reform", in which the government helps shift reimbursement of quality and efficiency over simple volume. For example, in the current volume-based system, a Primary Care Physician (PCP) makes money by seeing as many patients as possible in their office. The result is increased cost for patients and insurers, and a shortage of PCPs to do all this work. In a value-based system, a PCP could oversee a team of nurses who manage a much larger group of patients - taking care of the stable ones via phone and web-based services, and only needing to see the sickest and most complicated patients in the office. The result would solve both the cost and access problems we face!

Fortunately, this issue is not lost completely in this insurance reform bill. Atul Gawande, MD, correctly points out in a December 2009, New Yorker article, that the current bill does provide some ability to "test" new reimbursement ideas. Let's hope that those tests quickly prove some ideas which can then be extrapolated... because otherwise we will look back on a collapsed healthcare system in a few years and point to all these problems we know about, and say we wish we had done reimbursement reform sooner.