The U.S. Supreme Court ruling on the Affordable Care Act (ACA), Obamacare, won't be -- and shouldn't be -- the last word on health reform. Setting aside the hyperbolic rhetoric on what the legislation does and doesn't do, there remain good reasons to both support and oppose ACA.
In fact, the two of us don't see eye-to-eye on the legislation. One of us believes that the bill was the best that could be achieved under the circumstances and that providing coverage to an additional 30 million Americans, as ACA will do, starts the long-overdue journey to comprehensive health reform. The other sees ACA as a worrisome expansion of federal control and coverage without corresponding (and necessary) controls on costs.
However, despite our differences on ACA, both of us do agree that with or without ACA the soaring cost of health care will undermine the private health care marketplace and crowd out other important public priorities. In fact, the Minnesota Department of Health reports that in the next decade, health spending in Minnesota will double -- and that doesn't even include the rising cost of long-term care (not a comforting prediction in a rapidly graying state).
We also agree that, whatever the Supreme Court decides, the delivery and financing of health care need to change in fundamental ways.
Start with the current financial incentives. Today, doctors, hospitals and other providers typically are compensated for every service they provide, not for improving the patient's health. That has to change. New payment systems are needed to reward caregivers on the basis of outcomes, not procedures.
One barrier to meeting this goal is the fragmentation of health care delivery. A primary care physician, specialist and hospital may be treating the same patient, but with little awareness of what the others are doing. Some Minnesota health systems are among the nation's leaders in developing new ways to coordinate care. That's especially important for managing the costs incurred by the 10 percent of patients -- mostly those with chronic diseases -- who consume nearly two-thirds of all health dollars.
The role of consumerism in cost control also deserves scrutiny. There is a difference between having "skin-in-the-game" and simply being skinned. Today's "consumer-directed" health plans mostly call on individuals to pay more for health care through higher insurance premiums and deductibles. But that alone doesn't make us smarter consumers.
To be better buyers of health care we need better information, especially at decision-making time. Websites, quality ratings and other tools are useful, but nothing beats the ability to talk directly to a doctor or nurse about a specific procedure, especially if the patient knows enough to ask the right questions and the care provider is paid for the time to have the conversation.
