Epilogue?

I am an optimist by choice - not by nature. I arise each day and metaphorically cloak myself in a robe of 'learned optimism.' But I have to tell you that it's sure been difficult for me to remain optimistic in the face of the partisan political rancor that marked the final chapters of the health care reform legislative process. So much so, I found that my muse had left me after my last washingtonpost.com posting in November. I'm back for the final weigh-in.

Now that the bill has passed, we've been left to figure out the ramifications of the myriad disparate pieces described in more than 2,400 pages. It's a mixed bag to be sure. As a Family Physician I feel that the bill offers some important validation for the critical role of Primary Care in the health care delivery system of the future. As a vendor of population health and wellness services delivered from an on-site clinic platform I see reasons for companies to still want to purchase my service offering. As an off-shoot of a large employer, I've come to the conclusion that overall, the bill is more negative for American businesses, and hence the American people, than positive. The new law missed its opportunity to address the anti-competitive burden that health care presently places on American businesses, now competing in a global economy.

Although the regulations are just beginning to be written, what we do know is this: access to insurance coverage has been expanded to 32 million additional lives. That's a good thing. But at what cost to American employers? The tax implications of this bill are just beginning to be appreciated; and in cases like Caterpillar and AT&T they're staggering. The bulk of the actuarial analyses I've read suggest that companies, like my parent company Quad/Graphics, will be paying more in a variety of ways such as the new long-term care tax, and providing benefits for part-time employees we never had to cover before. Our lifetime limits are now removed and we'll have to cover dependents to age 26.

If there's a glimmer of hope for me in this new law it's in the funding for pilot projects supportive of Accountable Care Organizations and Patient-Centered Medical Homes. Because, to paraphrase what I wrote in my very first essay in this space, the fundamental dysfunctional health care dynamic is this: excess costs are driven by the perverse incentives inherent in our disaggregated, piece-work delivery model.

Where do we go from here? The more-government-is-better crowd on the left see this as the first step to nationalizing U.S. health care and will continue to press their fight. The anti-entitlement folks on the right see this new law, foisted on them in so partisan a fashion, as a clarion call to close ranks and re-energize. Their hunt is on for a 21st century Ronald Reagan. This is just the first major battle in what's likely to be a protracted war.

For my part, I plan to continue to work to improve the health of the folks that have been entrusted to me - from QuadMed's empowered primary care delivery platform - one person at a time.

By Raymond J. Zastrow  |  April 1, 2010; 12:25 AM ET Save & Share:                 
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