A lot has happened, still more to be done
While our legislators have certainly made strides toward health-care reform over the past year, there are several areas in which I would hope for a different outcome.
In general, I've been disappointed in the political process, specifically in regard to the Republicans' refusal to engage in substantive contributions and Democrats using their critical individual votes to extort "deals" for their states. Alas, I suppose it would be naive for me to suggest the process could improve if there was less "politics" involved.
It's unfortunate that the focus has been on extending coverage rather than improving how coverage is provided. Our current system has significant room for improvement in the consistency, quality and delivery of care. Expanding the current system to a larger number of people may not be best.
Along with improving care, health-care reform should more aggressively tackle the issue of a flawed payment system. As I've mentioned previously, our current system provides incentives for medical providers to give patients as much treatment as possible in the form of procedures, diagnostic tests, etc. Real reform needs to address this issue head on.
I would like to see greater engagement from the public in the reform process. I fear that, because the bills are so long, the public does not understand the legislation and instead relies on what they hear from their favorite commentator--which can be biased. In my opinion, public opinion polls don't represent accurate knowledge.
As a perennial optimist, I believe a bill will be passed, and, hopefully, there will be opportunities to fine tune the implementation. The secretary of Health and Human Services will have those opportunities to initiate pilots and programs to improve how care is delivered.