Understanding Health Care Reform: Bridging the Gap Between Myth and Reality PDF

Preface

A Cure? Understanding the Patient Protection and Affordable Care Act

America's health care system is broken. Our health care costs are higher than in any developed country, yet we rank twenty-seventh in the world in life expectancy. Increasing premium costs force middle-income families to purchase benefits packages that are so skimpy that a serious medical problem could wipe out their savings. Thousands die and millions declare bankruptcy each year because they have no health insurance at all. In March 2010, after nearly a year of debate, Congress passed and the president signed the omnibus Patient Protection and Affordable Care Act to reform this nation's health care system and to provide insurance coverage for 35 million of the 50 million Americans who are uninsured. The most significant social legislation since the civil rights legislation and the creation of Medicare and Medicaid in the 1960s, the bill's passage has been met with great controversy.

People on the left of the political spectrum bemoan the fact that the bill does not include a government-run single-payer universal health care system while those on the right view the bill as socialized medicine that is being foisted on an unaware public. The majority of those in the middle of the political spectrum find that the nearly 1,000-page bill is difficult to understand. Many Americans have left the interpretation of the bill to the political pundits, politicians, health care economists, and policy analysts who have filled the airwaves and the lay press with their opinions. Even the many articles that have appeared in prestigious medical journals have been in large part authored by nonphysicians. Little has been heard from those who have the most invested in health care delivery reform-patients and their doctors.

During my medical career, I have been fortunate to care for patients, teach students, and pursue research at some of America's foremost hospitals and medical schools. I have served as a division chief, a department chair, the president of two professional organizations, a college trustee, the editor of a medical journal, and the founder and director of a biotechnology company. These activities have taken me to academic medical centers and teaching hospitals in thirty different states and fifteen different countries, to the Food and Drug Administration, and to the Centers for Medicare and Medicaid Services. I have seen health care delivered in towns as small as Haynesville, Louisiana, and Clarksburg, West Virginia, and in cities as large as Baltimore and Philadelphia. While all of these experiences have informed my opinions on our health care system and on the need for health care reform, no experience has been as instructive as becoming a patient. In November 2009, in the midst of the congressional health care debate, I was diagnosed with prostate cancer. Being a patient in this health care system has transformed my thinking about health care reform in ways that I could not have imagined. It was the dual perspective of patient and physician that led me to write this book.

Health care reform was designed to be a work in progress. The Patient Protection and Affordable Care Act states that the "secretary [of Health and Human Services] shall" or the "secretary may" establish a variety of institutes, centers, regulations, demonstration projects, pilot projects, and oversight bodies in 1,000 different places. It is these groups and programs that were given the task of creating new policies. In many cases the law stipulated that it would be the state legislatures and not the federal government that would develop new rules and regulations governing the health care industry. Because it will take over a decade for all of these pieces of reform to come together, it was generally assumed that there would be numerous opportunities for informed voters to provide meaningful input.

The mid-term elections of 2010, seen by many as a referendum on health care reform, created enormous uncertainty as to what reform would actually look like as key elements of the legislation were placed in jeopardy. The bill authorizes health care spending by federal agencies. However, the funds to be spent must be separately appropriated by the Congress each year. The Republican majority in the House of Representatives could make appropriations for health care reform problematic. Furthermore, victories by antireform governors and state legislatures may have crippled the ability of some states to carry out effectively their share of the financial and regulatory burden of new programs. Attorneys general in over half of the states are in fact challenging the constitutionality of critical elements of the new bill, placing its mandates at further risk, while the voters of some states have opted out of health care reform altogether.

My goal is to provide you with the information you need to make informed decisions and to help counter the bias of political pundits and the influence of the for-profit health care industry. I will do this by introducing you to a group of dedicated doctors, administrators, and interesting patients whose experience with our health care system will illustrate the strengths and weaknesses of the health care reform legislation. I will tell you about a talented health care administrator who tried unsuccessfully to turn around a safety net hospital in one of America's most economically deprived areas. You will meet a young physician who was diagnosed with cancer of the lung and learn about a new and exciting treatment for which insurance company refused payment. The story of a physician who has worked tirelessly to stem the epidemic of obesity and hypertension in inner-city Philadelphia will illustrate why preventing chronic disease is both expensive and difficult. You'll visit a community on the Louisiana-Arkansas border and learn how dedicated doctors and nurses face the challenges of delivering care in rural areas and how the Patient Protection and Affordable Care Act will affect their practices. And I will tell you about my own experiences with our health care system and the experiences of my patients-to illustrate both the strengths and the weaknesses of the health care reform legislation and why our current health care structure is unsustainable without reform.

Many excellent books have been written on our health care system, most of which have been authored by health care economists, social scientists, and health policy analysts. I am writing as a doctor and as a patient for anyone interested in contemplating the practical issues associated with our new health care reform legislation. This book is not about what is right or wrong with our system. It is focused on providing an understanding of the strengths and weaknesses of the health care reform legislation, explaining how doctors, patients, and families can determine the success or failure of the legislation over time, describing what we need to do to ensure that this landmark legislation succeeds in achieving its goals, and providing an accounting of steps that our elected representatives can take to improve the bill-and how ill-advised actions could threaten your ability to obtain high-quality and timely care. This book cuts through the political rhetoric and focuses the reader on the core question-what do we need to do to preserve our ability to provide the best possible care for our population and to fulfill our societal mission of providing care for our citizens independent of their financial means?

You may agree or disagree with me. But if I have encouraged you to think creatively about how you will play a role in creating a better system of health care in America, then I have fulfilled my goal in writing this book and you will become a good steward of our health care system.