After nearly a year of debate, in March 2010, Congress passed and the president signed the Patient Protection and Affordable Care Act to reform the U.S. health care system. The most significant social legislation since the civil rights legislation and the creation of Medicare and Medicaid, the bill's passage has been met with great controversy. Political pundits, politicians, health care economists, and policy analysts have filled the airwaves and the lay press with their opinions, but little has been heard from those who have the most invested in health care delivery reform-patients and their doctors. Understanding Health Care Reform: Bridging the Gap Between Myth and Reality provides readers with the information to make informed decisions and to help counter the bias of political pundits and the influence of the for-profit health care industry. The author introduces readers to a group of dedicated doctors, administrators, and patients whose experiences illustrate the strengths and weaknesses of the health care reform legislation. He also shares his own experiences as both a physician and a patient.
The book puts the health care reform legislation in perspective by exploring ten critical areas: The private insurance industry Medicare and Medicaid The elimination of waste caused by overutilization, high administrative fees, and fraud Disease prevention and wellness programs Care for the underserved-the health care "safety net" Quality of care The impending workforce shortage Comparative-effectiveness research to compare treatments Changes in the way medicine is practiced Tort reform Describing the reform act as the foundation and framing of a house, it outlines what doctors, patients, and families must focus on as states, the federal government, and the courts craft this legislation over time. The author cuts through the political rhetoric to address the core question: how do we preserve our ability to provide the best possible care for patients and fulfill our societal mission of providing care for our citizens independent of their financial means? Focusing on strengths and weaknesses, rather than what is right or wrong, he encourages readers to think creatively about their role in establishing a better system of health care in America.
Introduction Reforming the Private Insurance Industry The Private Insurance Industry in the United States Reforming the Private Insurance Industry Flaws in the Patient Protection and Affordable Care Act Strengthening the Health Care Reform Legislation Notes How Will Health Care Reform Affect the Medicare and Medicaid Populations? About Medicare How Does the Health Care Reform Legislation Change Medicare and Medicaid? The Independence at Home Program Medical Homes Accountable Care Organizations The Extension Program Hub Community Health Centers Lowering Medicare and Medicaid Costs State Governments and Medicaid-Medicare Reform Lowering Health Care Costs through Health Care Reform Notes Can We Lower Health Care Costs by Eliminating Waste? Medical Waste and Economic Waste Cost-Benefit Analysis Controlling Medical and Economic Waste Medical Spending in the Last Days of Life The Patient Protection and Affordable Care Act and Waste Placing the Burden of Cost Control on the Patient Placing the Responsibility for Decreasing Waste on Hospitals Unintended Consequences of Attempts to Eliminate Waste Developing a Rational and National Strategy to Reduce Waste Notes The Role of Disease Prevention in Health Care Reform Prevention and Wellness Programs in the Patient Protection and Affordable Care Act Section 2705 of the Patient Protection and Affordable Care Act-Legislating Wellness! The U.S. Preventive Services Task Force: Another Potential Flaw in the Patient Protection and Affordable Care Act Prevention Doesn't Lower Health Care Costs-It Might Actually Increase Them! Addressing the Epidemic of Obesity-And Health Care Reform Individuals Must Often Support the Costs of Prevention Steps to Ensure Prevention and Wellness Notes How Will Health Care Reform Affect the Medically Underserved and the Safety Net Hospitals That Care for Them? The Health Care Safety Net The History of Safety Net Hospitals Disproportionate-Share Hospital Payments Safety Net Hospitals Falter When DSH Funds Are Redirected to Pay for Health Insurance The Patient Protection and Affordable Care Act Threatens the Country's Safety Net Pay-for-Performance Can Also Threaten Safety Net Hospitals The Health Care Exchange Will the Exchanges Work? Some States Are Ahead of the Curve-Others Behind It Health Care Reform in Massachusetts: A Template for Health Care Exchanges? How Can the Patient Protection and Affordable Care Act Be Modified to Protect the Safety Net? Notes How Can We Improve the Quality of Care in the United States? The Cost-Quality Conundrum The Dartmouth Atlas and Health Care Reform Measuring Quality of Care Measuring Quality of Care: The Health Care Reform Legislation Pay-for-Performance The Electronic Health Record Value-Based Purchasing Substantive Steps Taken by the Patient Protection and Affordable Care Act What Additional Steps Should Congress Take to Ensure Quality of Care? Notes Will There Be Enough Doctors to Care for 35 Million New Patients? How Does the Patient Protection and Affordable Care Act Address the Workforce Crisis? The 1997 Balanced Budget Act and the Health Care Workforce Crisis The Changing Demographics of the Physician Workforce The Workforce Crisis Is Not in Primary Care Alone Lessons from Massachusetts How Have We Approached the Need to Increase the Number of Practicing Physicians in the United States? Danger around the Corner What Should We Do to Increase the Size of the Health Care Workforce? Notes Can Research Guide Us to Improved Care at Lower Costs? Why Comparative-Effectiveness Research Has Become a Lightning Rod in the Health Care Debates The Patient Protection and Affordable Care Act and Comparative-Effectiveness Research The Potential Value of Comparative-Effectiveness Research Can Comparative-Effectiveness Research Lower Costs? Limitations of Comparative-Effectiveness Studies Using Comparative-Effectiveness Research Notes How Will Health Care Reform Change the Way We Practice Medicine? Physician Compensation The Sustainable Growth Rate How Did the Patient Protection and Affordable Care Act Change the Way Doctors Are Paid? Pay-for-Performance Payment Bundling Global Payment Electronic Health Records Multispecialty Group Practices The Independent Payment Advisory Board How Can the Patient Protection and Affordable Care Act Be Improved? Notes Will We Ever See Tort Reform in the United States? The Current Tort System Malpractice Caps The Patient Protection and Affordable Care Act Failed to Address Tort Reform Medical Malpractice-A Silent Disease Employment Law and the Health Professions It Is Not Too Late-Novel Strategies for Reforming Our Tort System Notes Conclusion Surviving Health Care Reform Notes Index