Column 100 - Reflections on the recent past with the ACA

Column 100- Reflections on the recent past with the ACA

This is my 100th column for the Record Searchlight so it seems like a good time to reflect on the last couple of years. 

As I said in my introductory column, I am in a rather unique position to observe the health care delivery and financing systems.  I have served on advisory boards of a hospital and a major insurer.  I have clients from across the spectrum: medical billing, doctors, labs, therapists, clinics etc.  I have assisted family members through severe and chronic illness as well as hospice.  I have family members that are Personal injury attorneys, physicians, directors of pharmacology for big pharma. This gives me the opportunity to learn their challenges from their perspective.

As an agent since 1978, I have worked at all levels of this incredibly fragmented system.  This includes individual and group health insurance, workers comp, Medicare, Medi-CAL, etc. I have watched costs soar and quality dive.  When the ACA (Affordable Care Act aka Obamacare) was introduced I was admittedly hopeful.  To see most of parties step up and each be willing to give a little to attempt to fix the system was encouraging.

This was to be a modified employer based model, not a single payer system.  It was designed to build on the foundation of existing US employer sponsored coverage.

The provisions that were (and continue to be) most exciting to me were in outcomes research and electronic medical records. 

I liked the idea of the ACO (Accountable Care Organization) that could possibly be structured like the Mayo or Cleveland clinics, with collaborative medicine and financial incentives for success.  Success is defined as treating the whole person, not just one surgical intervention. 

I liked the fact that it was funded.  While I surely don't like the increased taxes, I knew that this was not going to come for free.

I loved the idea of universal coverage that included guaranteed issue for individuals.  Never again would I have to tell someone they were declined due to a pre-existing medical condition!

I did not like having my commission income drastically cut.

I have heard a lot about older persons in health related fields that are simply retiring.  It's just too much change!  I get that!  I heard my doctors complain about Electronic Health Records.  But interestingly, the new young woman who is my doctor seems as comfortable on her I-Pad making notes as he was scribbling in my chart.

Lots of good concepts in the law, but, oh the details of implementation!  I have said we have to give it 5 years.  Since the last phase-in is 2018, I guess 2023 would be a fair time to assess the success of the ACA.  Anecdotally, we can point to successes and failures, but it is premature to judge it overall. 

However, since this is a legislative solution, politics is involved.  It's impossible to let this really have a full "chance" because politicians are inherently involved and the players are ever-changing. 

The most significant change has been to see the country actively involved in discussions about these topics.  Any change requires disruption and that is exactly what we are experiencing.

One of the most powerful books I have read on this topic was referred to me by my friend David Civalier MD.  His university degree before his MD was engineering, so clearly this is an analytical guy.  "The Innovator's Prescription" A disruptive Solution for Health Care was written by a professor and two MD's.  I would encourage everyone with an interest in this topic to read the book. 

It gives me just a little more hope that there is positive change coming.  It will take a while to get to our rural areas, because a lot of the disruption requires economies of scale, best experienced in a densely populated area.  But much like the "Alameda Model" for mental health care that was presented last week at the Cascade Theatre, it shows that there are multiple paths.  Perhaps some of our rural areas can effect these changes, simply because we are farther away. 

One disruptions is Telemedicine, where specialty consults are a televised experience is a much more efficient way to see a specialist than driving 250 miles for a 15 minute appointment.  If our primary physician is involved at the same time, all the better!  CVS Minute Clinics are another.

Another suggestion is the evolution to Personal Health Records that are standardized.  The data would be mine and the money would be in developing apps for vendors to use my data. I will write more about this book later.

Admittedly, I feared that the ACA would put me out of business.  But I have found that so much change makes a well-informed agent extremely valuable to employers and individuals.  And, I still like the challenge!