Liv­ing in un­cer­tain times

Some sim­ple lessons from our na­tion’s farm­ers and health­care providers

Modern Healthcare - - OPINIONS|EDITORIALS - DAVID MAY As­sis­tant Manag­ing Ed­i­tor/fea­tures

What’s hold­ing back the econ­omy? What’s trou­bling Wall Street? What’s re­ally ail­ing Amer­ica’s health­care sys­tem? It’s quite sim­ple: There’s just too much un­cer­tainty. All we need is a lit­tle more con­fi­dence about what the fu­ture might hold and ev­ery­thing should start to im­prove sig­nif­i­cantly. Or so we’re told.

We hear it con­stantly. If only small busi­nesses could be more cer­tain about their reg­u­la­tory burden or their ef­fec­tive tax rates, they might be more will­ing to start cre­at­ing more jobs. Af­ter all, they are the job creators. So we’re told.

The U.S. Supreme Court’s rul­ing on the Pa­tient Pro­tec­tion and Af­ford­able Care Act was fi­nally go­ing to bring about more clar­ity and cer­tainty re­gard­ing the law’s far­reach­ing ef­fects on em­ploy­ers, pay­ers, pa­tients and providers. So we were told.

The eu­ro­zone’s pub­lic-debt pan­demic has spread from Greece to Spain to Italy and be­yond. Back home, Tax­maged­don lurks. The fis­cal cliff looms. And a com­pet­i­tive pres­i­den­tial race is near­ing the home stretch.

Oh for even a small dose of that elu­sive cer­tainty to soothe our angst. Un­for­tu­nately, that medicine would be snake oil. Blam­ing a lack of cer­tainty for our dys­func­tional de­ci­sion­mak­ing is more prop­erly la­beled ex­cuse-mak­ing, be­cause with very few ex­cep­tions, cer­tainty is not of the real world.

Ku­dos to the lead­ers, in­no­va­tors and la­bor­ers, no mat­ter the in­dus­try, who move for­ward in their work weigh­ing risk and re­ward but al­most al­ways tak­ing a leap of faith to some de­gree.

Con­sider the na­tion’s farm­ers, es­pe­cially in this sum­mer of record­break­ing heat. Their ef­forts are al­most the ex­act op­po­site of bet­ting on a sure thing. Ev­ery­one knows how fickle na­ture can be, but how many of us would have guessed that dur­ing this sea­son nearly 80% of the coun­try would ex­pe­ri­ence some level of drought? How­ever dis­mal the fi­nal har­vest, farm­ers will be back next year, we can be sure of that.

Also de­serv­ing recog­ni­tion are the health­care play­ers, no­tably hos­pi­tals, physi­cians and pay­ers, that continue to take a chance on the grand ex­per­i­ment of ac­count­able care. The con­cept, driven by pro­vi­sions of the health re­form law, pro­motes im­proved care at lower cost through a co­or­di­nated ap­proach em­pha­siz­ing well­ness and preven­tion. And the play­ers get to share in sav­ings achieved.

As Mod­ern Health­care re­porter Me­lanie Evans writes in our sec­ond an­nual Ac­count­able Care Or­ga­ni­za­tions Sur­vey re­port (See pullout sec­tion op­po­site this page), many ACO part­ners were will­ing to take a chance on the sus­tain­abil­ity of the con­cept even be­fore the Supreme Court ruled on the le­gal­ity of the ACA. Strik­ing down the law would have put Medi­care’s sup­port of the pro­gram in peril.

As Evans writes of one health sys­tem in­vest­ing in an ACO, “Of­fi­cials be­lieved that prepa­ra­tion for Medi­care ac­count­able care would not go to waste de­spite the un­cer­tainty ahead of the (Supreme Court) de­ci­sion. If the court threw out the ACA—and with it, Medi­care ac­count­able care—fledg­ling com­mer­cial ef­forts would nonethe­less continue.”

Lastly, we would like to pay trib­ute to an­other per­son who never let big-time un­cer­tainty get in the way of a pi­o­neer­ing role in our na­tion’s his­tory. This per­son is Sally Ride, who be­came Amer­ica’s first woman in space with her trail-blaz­ing flight aboard the space shut­tle Chal­lenger in 1983. Ride died last week at age 61 af­ter a bat­tle with pan­cre­atic can­cer. Her vo­ca­tion and pas­sion, in ad­di­tion to her risky work at NASA, in­spired chil­dren, es­pe­cially young girls, to learn to love the sub­jects of math, sci­ence and engi­neer­ing, just as she did.

She will be missed, but her legacy is in­deed cer­tain.

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