There is no such thing as a perfect piece of legislation, especially on an issue as contentious as health care. This legislation had many positive components and it creates not only major insurance market reform, but transformational payment, delivery, access and quality reform. There are many good pieces in the legislation on prevention, long-term care and on addressing some issues with the senior citizens prescription drug program.
All that being said, I am deeply concerned that we have created a larger health insurance system prior to fixing what is broken in the current system. Because many of the fixes in terms of quality, delivery and payment reform depend on future actions by regulators and cabinet agencies, it is too tempting for special interests to fight to preserve what's wrong with our system. In a personal blog I posted today on www.mikecritelli.com, I used the example of a New York Times story about a poor quality hospital in New York that the state recommended be closed. Because it was a large employer and a major community resource, it was never closed.
To make this legislation work as intended, we must make politically difficult decisions to reallocate health care payments, expose badly-performing health care providers and to shift from putting too many resources into specialist care, wealthier communities, and complex treatments versus low-cost wellness activities. I have seen no evidence that we have the political will to make these decisions. I will try to be part of the solution, but this legislation, by building on the existing system before fixing it, has made transformational health care reform far more difficult.
Thankfully, there are many good transformational tools in the legislation, but our collective responsibility is to make sure they get used.