Top health­care chal­lenge could be find­ing long-last­ing so­lu­tions to sys­tem’s ills

Modern Healthcare - - NEWS -

Find­ing long-last­ing so­lu­tions is our big­gest chal­lenge

If all goes ac­cord­ing to plan, next sum­mer should be a mighty in­ter­est­ing time in Amer­i­can pol­i­tics. That’s when, in the heat of the pres­i­den­tial cam­paign, the na­tion is likely to learn the fate of the health­care re­form law, at least ac­cord­ing to the col­lec­tive wis­dom of the U.S. Supreme Court.

That tim­ing could be off, but the im­pact of the rul­ing will be jolt­ing no mat­ter when it comes, given the light­ning rod per­ma­nently af­fixed to the Pa­tient Pro­tec­tion and Af­ford­able Care Act. And the de­ci­sion will be elec­tri­fy­ing no mat­ter which way it goes.

As has been re­ported ex­ten­sively in the past week, the high court has agreed to take on sev­eral le­gal chal­lenges to the re­form law, al­lo­cat­ing an ex­tra­or­di­nary amount of time for oral ar­gu­ments next spring for both sides to make their case.

While the jus­tices seem to have an “out” al­low­ing them to punt the de­ci­sion to 2014 be­cause of the in­tri­ca­cies of one chal­lenge to the law, let’s keep our fin­gers crossed that the court doesn’t take that route. It will be ex­tremely ben­e­fi­cial all around to have clar­i­fi­ca­tion from the top court over whether Congress and the Obama ad­min­is­tra­tion over­stepped their con­sti­tu­tional au­thor­ity or if in fact the law­mak­ers got it right.

With the SCO­TUS re­view now just over the hori­zon, it’s a worth­while ex­er­cise to re­mem­ber what led to last year’s pas­sage of the Af­ford­able Care Act, af­ter some 100 years of trial and er­ror on health­care over­haul leg­is­la­tion.

While the myr­iad chal­lenges fac­ing health­care de­manded that Washington fi­nally take ac­tion, let’s re­mem­ber two key driv­ers: ac­cess and cost. The Af­ford­able Care Act takes the is­sue of ac­cess head-on, aim­ing to greatly ex­pand in­sur­ance cov­er­age and avail­abil­ity of care. Fix­ing the prob­lem of cost will prove much trick­ier, and it’s where leg­isla­tive re­fine­ments are needed.

If the re­form law’s mech­a­nisms de­signed to de­crease the num­ber of unin­sured by 30 mil­lion start­ing in 2014 fail to be im­ple­mented as a side ef­fect of any high court rul­ing, there’s one sim­ple ques­tion: What’s the al­ter­na­tive plan? Haven’t seen one yet that ap­proaches the ACA’S am­bi­tious goals, with the ex­cep­tion of a Medi­care-for-all sin­gle-payer plan.

There’s no doubt that ac­cess to health­care con­tin­ues to be in­hib­ited. An Oc­to­ber re­port from the Com­mon­wealth Fund ti­tled Why Not the Best? Re­sults from the National Score­card on U.S. Health Sys

tem Per­for­mance, 2011 points to con­tin­ued short­com­ings in the U.S. health sys­tem’s abil­ity to de­liver af­ford­able, ac­ces­si­ble and ef­fi­cient care. The re­port, based mainly on 2007-09 data, noted a drop in scores com­pared with sim­i­lar analy­ses in the past two years.

“Of great con­cern, ac­cess to health­care sig­nif­i­cantly eroded since 2006. As of 2010, more than 81 mil­lion work­ing-age adults—44% of those ages 19 to 64—were unin­sured dur­ing the year or un­der­in­sured, up from 61 mil­lion (35%) in 2003,” ac­cord­ing to a summary of the re­port. “Fur­ther, the U.S. failed to keep pace with gains in health out­comes” achieved by other lead­ing na­tions, the summary states.

Mean­while, ear­lier this month, the Gallup or­ga­ni­za­tion noted an­other de­cline in its Gallup-health­ways Ba­sic Ac­cess In­dex, which uses 13 met­rics, in­clud­ing Amer­i­cans’ abil­ity to af­ford food, hous­ing and health­care, to gauge our over­all well-be­ing.

For Oc­to­ber, the in­dex fell to its low­est point since its in­cep­tion in 2008, mean­ing it was weaker than dur­ing the worst months of the Great Re­ces­sion. Health­care mea­sures that are part of the cal­cu­la­tions in­clude health in­sur­ance cov­er­age and ac­cess to care­givers and med­i­ca­tions.

So it’s ob­vi­ous the U.S. con­tin­ues to strug­gle with ac­cess to health­care. What’s even more ap­par­ent is that, de­pend­ing on the high court’s de­ci­sion, we might have a tougher time gain­ing ac­cess to long-last­ing so­lu­tions.

DAVID MAY As­sis­tant Man­ag­ing


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