Health Care Reform Without a Revolution0

This article was first published in the Los Angeles Daily Journal on July 9, 2014.

iStock_000003498126MediumHealth care reform is insignificant in comparison to the fundamental purpose of the system it must change. Unlike a terminal illness, which doubles as a harbinger to remind us of the inescapable permanence of death, much of the influence of health care reform over which the nation has debated these past four years will prove to be fleeting at best. Time will shape and reshape the Affordable Care Act (ACA) in ways outside today’s imagination, but the hospital bed, that symbolic and functional centerpiece of American health care, will never be anyone’s destination of choice.

The transformation of Medicare from its humble origins in 1965 into the template for American health care’s payer system was certainly no small feat, although maintaining the Part B premiums at Medicare’s original price tag of $3.00 per month never stood a chance. Whether as a result of Medicare’s effect or in spite of it, advances in medicine since 1965 have played a large part in the program’s evolution, with today’s emphasis on performance in lieu of costs standing as a reflection of an inherent expectation that modern medicine should have the twofold intention to never do harm and excel at all times. Perhaps ACA’s greatest achievement is that it has granted an aura of entitlement to all hospital patients, for now society has not only come to expect quality medical care at any time, it also expects this service free of charge.

A centerpiece of the ACA, health insurance exchanges have taught us that such the conception is often delusional at best, and  when put into practice, not all insurance plans are created equal (though they may be identical). With a Herculean push on the part of the state exchanges to offer the very same plans as those in place before 2014, in many instances no one remembered to send a memorandum to the providers that resistance was futile, or that reimbursement was identical. Most likely health care providers and exchanges will eventually synchronize, and hopefully sooner than the time it has taken Medicaid Expansion to make good on the raises it promised to the doctors who opened up their doors to the nation’s newest program beneficiaries.

The federal government has placed high expectations upon the health care industry throughout this new era of reform. Under the ACA, the future of health care must include marked improvements, greater access to care, and increased transparency, all of which must be delivered with epic levels of efficiency at a sharp reduction in price. The nexus between ACA standards and physician shortages remains to be seen, but it does not take an advanced degree to understand that in the final evaluation, the expanded delivery of health care is dependent on the success or failure of those who are trained in medicine.

To be sure, today’s physicians may take issue with certain tenets of reform, especially those who spent 20 years in study only to see the system turned upside down in less time than it took them to graduate from medical school. To add insult to injury, the federal government’s record-breaking results in its battle against health care fraud and abuse cannot avoid impugning the integrity of those health care practitioners who serve on the industry’s front lines, many of whom never really grasped the byzantine nature of these regulations that stock the armories of the Department of Justice and Office of the Inspector General.

Hospitals, too, must evolve under the ACA, or risk adding their names to the growing ranks of institutions now closed, many of which failed to navigate the economic principles necessitated by health care reform. The plight of local hospitals recently removed from the communities where they had for decades faithfully served and profited notwithstanding, this latest shift in health care’s financial paradigm should not be surprising to any institution directly descendent from the charitable almshouses that made up America’s health care facilities of yesteryear.

On the surface, it sometimes appears that none of contemporary America’s health care factions is pleased with the machinations of the ACA, or so the myriad legal challenges that have arisen would indicate. With issues ranging from matters of employment to taxation to contraceptive care, the United States Supreme Court has no shortage of controversial topics on which to opine. At its core, however, health care’s institutional foundation appears to have remained somewhat intact, even in light of recent criticism of the program’s overall expenses and inferior performance in comparison to the health care structure of other developed countries.

This past weekend we celebrated the nation’s freedom from England, but those patients and providers who now profess an inability to achieve their desired result under the ACA most likely will not prevail through revolution or any other call for independence. Instead, critics of health care reform should reflect upon the ACA’s limited role in the entire evolution of American health care, a system more than 238-independent years in the making. When it comes to the delivery of health care in the United States, we can even gain insight from the nation Congress chose to leave in 1776, or at least one Dartford, Kent-born scholar/musician-turned-knight to call to mind that those who participate in the system may not always get what they want, but more often than not they get what they need.

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