Blog | Monday, July 2, 2012

Finally, forward


The decision has been handed down from the highest court in the land.
Obamacare has been upheld. Chief Justice John Roberts skillfully parsed the individual mandate by calling it what it really is, a tax.

To make health care more widely available more affordably, it seems logical that we all have to share in the cost burden. Taxes are anathema to many of our citizens. But in life, you get what you pay for.

I have a few thoughts on health care reform.

Though no one is saying it, business leaders are not altogether unhappy with the decision. For the first time since WWII, the Affordable Care Act gives us the opportunity to uncouple employment from health insurance. To be sure, the legislation says that companies with more than 50 employees must offer insurance to their employees. But it also provides a penalty for not doing so, one that many companies are now weighing as a business cost more reasonable and less unpredictable than group health insurance. If the states and/or federal government truly can develop health insurance exchanges that offer lower-cost individual plans, then employees at such companies will be forced onto the open market. The upside of this is that no one will be locked into a job they hate simply because of its health benefits. Another potential upside is that firms will start hiring again–less scared off by benefit costs for employees.

There's enough federal dollars in the legislation aimed at innovation that we will finally be able to break the stranglehold of "fee-for-service" health care. [Fee-for-service: the more medical care delivered, the higher the payment--regardless of quality. More is just more. Remember, though, more is not better.] It will take many years. But by stopping the spending orgy that is fee-for-service and allowing quality-based models of reimbursement, we may actually see the pace of health care cost inflation decelerate.

Last thought: Atul Gawande wrote an excellent reaction to the SCOTUS decision that puts health care reform in its historical context as a longstanding societal "wicked" problem. It's worth a read. Click here.

This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.