The end of the 2012 race for the White House opens a new chapter in the movement to bring reform to America’s health care system. Several thoughts come to mind as the health care debate morphs into the reality that the Affordable Care Act, Obamacare, will remain as a permanent part of our social and health care fabric.
For one, there is a certain finality surrounding ACA. It will take its place alongside Medicare and Medicaid as the last major effort of the
federal government to provide health care coverage to a large segment of Americans. Second, a diverse group of businesses, health care providers of all types, state governments and individuals can begin to craft workable approaches to this new reality.
These approaches will include implementation and modification but are not likely to include serious efforts to repeal. Such course setting is extraordinarily important and helpful. Markets react well to certainty. Humans find comfort in what’s familiar and that expectations we know will be maintained.
Long ago I used to officiate basketball. Early in my training I worked a game between two inner city rival schools. In the heyday of run and gun basketball, the speed, grace and power of these exceptional 14-year-old athletes was amazing. The gym was packed to the rafters like a district playoff game. The frenetic pace, the noise and the newness of the experience was almost overwhelming. I missed some easy calls and quickly found myself on the wrong side of both coaches’ temperaments. One coach kept saying, “Just call the game the same on both ends and give us a chance to coach our kids to victory.”
I have never forgotten that comment. He wanted consistency, even certainty, on how the game was being officiated. He had confidence that once the officiating environment was set, he could navigate his team to success.
With certainty comes the ability to plan ahead and make intelligent decisions that are likely, but not necessarily guaranteed, to produce good outcomes. For three years the uncertainty of the election has left hospitals, insurance companies and many others in a collective holding pattern. Uncertainty stifles creativity. Both organizations and individuals loath to embark on a new journey if there remains the nagging fear of wasted effort. Predictability is a bedrock principle.
Two colloquialisms support the certainty principle: “the sun will rise tomorrow” and “the only thing certain is death and taxes.” The former presents a forum for hope in a better day ahead. The later provides the comforting assurance that some things never change, whether we like it or not.
Like the sun rising, there are many good things about ACA. Thirty million more Americans will have some form of health insurance by 2014. Pre-existing conditions and life-time coverage limits that often bankrupt individuals and families are no longer part of the insurance coverage landscape. Preventive screenings for such things as breast cancer and cholesterol testing must be done with no out-of-pocket costs to individuals.
There is more to like, such as incentives for providers to invest in IT solutions like Electronic Health Records and Health Information Exchanges. Both will produce a seamless sharing of patient information leading to more efficient and effective medical treatments. Other incentives encourage migration to medical homes, improvements to consistency and quality of heath care delivery and a focus on better patient outcomes.
As with death and taxes, not all of ACA is so rosy. The biggest uncertainty involves ACA’s cost. President Obama has touted it as the key to reducing government expenditures, mostly through lower utilization and higher quality outcomes. Not only are these promised reductions seriously in doubt, but there is the unsatisfying certainty that ACA brings more taxes, more federal government bureaucracy, unfunded mandates and serious restraints on religious organizations. Imposing unwelcomed taxes is one thing, but infringement on religious liberty is extremely troubling.
In addition, there is the chance of higher insurance premiums for many individuals and the uncertainty of how businesses will react toward maintaining insurance coverage for employees. All of this is coupled with the nagging concern that the private sector is far better equipped to develop and affordably sustain real innovation in health care.
The Affordable Care Act is here to stay. It is now up to politicians of both parties, industry providers and to us as individuals to adapt and embrace the opportunities to reduce costs, improve quality and increase access for all Americans. As the sun rises tomorrow, I have faith in our ability to make it happen.
William F. “Bud” Barrow is president and CEO of Our Lady of Lourdes Regional Medical Center and its entities. Barrow has more than 30 years of experience in health care administration in multiple states. He serves as chairman of the Regional Policy Board of the American Hospital Association and is a board member and past president of the Louisiana Hospital Association.
MAY 17 Here's a column from James Gill, this time in the Advocate. Gill, who has jumped ship from the Picayune, writes about the absurdity of dueling polls in this post. The numbers are so wildly different, it is obvious that both sides are "cooking the books," he writes. In particular, he looks at Sen. Mary Landrieu, and how her recent actions in DC have been received by those polled. Gill's acerbic, amusing prose is a welcome addition to a paper so conservative as to be occasionally lacking in personality.
MAY 17 Blogger Tom Aswell continues delivering bombshells about the state education department and Gov. Jindal's education "reform" efforts. In this post, he reports that students in the Shreveport area have been signed up for a charter school without their knowledge or consent. Most interesting to Aswell is how this Texas-based charter (with ties to GOP types) got the personal student information it has, if the students didn't give it.
MAY 17 This post by JR Ball in the Baton Rouge Business Report is an interesting tongue-in-cheek look at recent Baton Rouge economic development efforts. Among the items he examines is the idea that gaining a Costco makes BR a "world-class city." (Really? All you need is a different brand of Sam's? MK!) This effort, and other recent ones, are all built on the taxpayer's back, with tax zones, tax incentives and tax rebates, Ball writes.
MAY 17 Blogger CB Forgotston is critical of the legislature's reliance on a revenue-estimating committee's decision to include projected tax amnesty income in this year's forecast. That's a problem, CB posts, because the deadline for these people to pay their taxes is June 30, 2014. So when do you think these people who haven't paid taxes in years are going to pay their taxes? Surely not before June 30, and that means the money won't be there for this year's budget, he argues.
MAY 17 Here's an interesting blog out of California by a Hollywood writer, attorney and academic named Brian Alan Lane. He blogs about higher ed, and was a whistle-blower in a scandal over false credentials. In this post, he takes aim at LSU's new top dog, King Alexander. It's convoluted and a little confusing, but it sure makes Alexander a lot more interesting than he was yesterday.
MAY 17 Blogger Robert Mann writes about the LSU Board's refusal to allow Dr. Fred Cerise to testify before the legislature about Gov. Jindal's plan to close down all the state's charity hospitals and dump the poor on the private system. It's hard to imagine anyone more qualified than Cerise to testify about that, so why would anyone try to prevent him doing so? Mann thinks it is because the powers that be aren't interested in hearing any truth about the plan.
MAY 17 This post on the Louisiana Sinkhole Bugle, a blog that notes developments in the Bayou Corne and Jefferson Island salt domes, talks about a proposed expansion of the salt dome storage under Lake Peigneur in Iberia Parish. Residents are working against it for several reasons, including two biggies: the sinkhole disaster in Bayou Corne and the continuing, unexplained bubbling on the surface of the Lake.
MAY 17 NOLA police arrested more people Thursday accused of either being involved in the Mother's Day shooting or hiding the suspect afterward, this Gambit story reports. The NOLA police chief said he suspects the whole thing was gang-related and throws out a challenge to the gangs: he's got informants now, he says, and he knows a lot more than the gangs want him to know. The people who live in the neighborhoods terrorized by gangs are ready to talk, he says.
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