The New Health Care System by David Nather is a good primer describing what is included in the 2010 healthcare reform legislation. It is clearly written and avoids the irrationality and rhetoric that has surrounded so much of the media coverage. In fact, the book does a pretty good job of exposing many of the myths and outright lies (death panels and rationing for example) that have been circulated.
To be honest, I lost interest and hope during the long political battles and I had assumed that the bill which finally passed was pretty insignificant and disappointing. Granted, it will not move us to a single payer system and it does rely heavily on the insurance industry, but overall, the results of this legislation are more significant and impressive than I expected.
Most significantly, the legislation will provide health insurance for 32 million people. It also makes lots of small changes that will hopefully improve the efficiency (and maybe even the effectiveness) of medical care. It really does seem like the intention of the changes were to align the financial incentives for health and for good, reasonable care while improving coverage. If successful in eliminating the costs associated with uninsured and with inappropriate use of medical services (ie. emergency room care for non-emergencies), the new system will be much closer to cost neutral than what I would have expected.
Most of the changes do not take effect until 2014 and by then we will have endured another presidential election campaign and undoubtedly more hysteria from the R’s about repealing “Obama Care”. One of the interesting subplots in this book were the explanations of how special interest groups attempted to preserve their benefits in the political process and, discouragingly, how much more savings and rational policies would be possible if there were political will and courage.
I was a little disappointed that the book did not go into more detail regarding “Medical Homes” and Accountable Care Organizations”. But, I guess I will just have to do my own research into these.
“In October 2009, the Institute of Medicine estimated that a third of all health care spending in the United States – about $800 billion – goes to medical care that doesn’t make us better.” So, 80% of the cost of the changes could be paid for by eliminating unnecessary and unproductive treatment and in return 32 million people can receive health insurance coverage. “This won’t make us the first developed country that protects people from bankruptcy if they get sick. We are just catching up with all the others.”
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