Health Care Reform: 2012-06-28

post by Bill Gardner

The Supreme Court has decided. After the ground stops shaking, stop and recollect the aims of health care reform: 

Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.

These aims have not been accomplished by the preservation of the Affordable Care Act, even though the alternative of overturning it might have been worse. 

1. Lack of insurance is not the only obstacle to accessing care, and even there the Affordable Care Act does not quite achieve universal access.
2. The US lacks the effective means to even measure many aspects of population health, let alone improve it.
3. There are striking disparities in life expectancy and morbidity, depending on your race, your social class, and where you happen to live. 
4. Health care costs continue to grow too fast. Merely reforming insurance will not be sufficient to reduce the growth of health care costs while preserving access and improving the quality of care. We need to develop better and if possible cheaper treatments for most conditions, and transform the institutions and professions that deliver care.

The task is about 1% completed.

Comments

[John LeBlanc]

Yes but thank goodness it's a step in the right direction. Imagine the setback if the tea-partyers had won.

[Anne]

Bill:
Your comments are accurate statements, but it seems they suggest that these problems can be solved through legislation, judicial decisions, or the medical system. Such problems as health disparities arise from the social structures our society has created. These are far beyond the ability of the medical system to correct. Meanwhile, it is truly heartening that the court agrees that as long as we label it correctly we can mandate that the entire population has health insurance. That is a critical step in creating a shared investment in the health of all Americans. it will take generations, but once it becomes obvious that the health of the poorest and the riskiest really does matter to everyone I believe the national mindset will become quite different.

[Bill Gardner (@Bill_Gardner)]

Anne,
It is true that the health care system cannot, in and of itself, remove disparities in health. I don't see the suggestion that it does in what I wrote, but I can't be the judge of my own writing.