The only thing certain is death and taxes - and Obamacare.
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.