Attention is focused this week on the Supreme Court as it holds an unusual three days of oral arguments about the constitutionality of the Affordable Care Act. At issue this week and in the ruling expected by the end of June are those provisions affected by the so-called “individual mandate,” which is really more of a proposed penalty than it is a mandate. In 2014, tax payers who do not certify to the IRS on their annual income tax filing that they have health insurance would be forced to pay a penalty. Whether you agree with it or not, the underlying reason was based on the fact that insurance markets work best when everyone is in the pool.
Somebody will find controversy in virtually any part of this law, which critics like to deride as Obamacare (ignoring that the individual mandate took life as a Republican idea). Health insurance exchanges are another – government-created marketplaces for individuals and small business to buy health insurance.
But beyond these controversial measures, the law is also a cauldron of vital experimentation about how to improve the cost and delivery of health care. And no matter what happens in the Supreme Court, on this aspect of reform there will be no going back. The people who provide care have begun to understand that for the people who purchase care and those who get care we can no longer sustain the crippling health care price inflation that is hamstringing employers and governments alike. In city after city, school boards are being forced to choose between higher health care costs and smaller class size.
The country is at last coming to grips with the fact that at $2.6 trillion and growing, health care is now gobbling up more of GDP than we can afford, about one in six dollars. The incentives in our system today reward doctors to produce quantity, not quality, when it comes to health care. They get paid for volume, not value. People know more about the quality of the toasters they buy than the health care they receive, and no one, not even your doctor, know what the care really costs.
Reforms that attack the quality and cost of the system – that is, to raise quality and lower cost – are here to stay. Purchasers and providers are both on record saying this genie cannot be put back in the bottle. And that’s a good thing. Because if something doesn’t change, we’ll continue to stagger toward a future in which health care swallows the economy.
Chuck Alston
Chuck Alston is senior vice president and director of public affairs at MSL Washington. He works on public affairs, marketing, policy and reputation issues for diverse corporate and non-profit clients, with a specialty in health and medical issues.
