Well, a first–and revolutionary–change in how American health care is financed and organized has been passed into law.  What’s next? There’s sure to be much more political and legal wrangling before the eventual nature of the law emerges. And controversy is the name of the game.

Ironically, there doesn’t seem to be much controversy about  some of the key goals of the legislation:

1. More Americans should have access to affordable health care. And that means that poor health should not result from inability to obtain medical care.

2. Health care should not be so expensive–that is, high medical bills should not lead to poverty, and health care  should consume a smaller portion of the GDP.

3. Health care should deliver high quality. In the language of the esteemed Institute of Medicine, it should be Safe, Timely, Effective, Equitable, Efficient, Patient-centered  (the acronym is STEEEP) .

The big disagreements stem from the means of achieving these goals and there is concern–even among supporters of the federal legislation–that the present law will not achieve these goals. Some call it “insurance reform, not health care reform.”  Opponents of the bill argue that the present system (I’d argue that it really isn’t a “system” at all) is so complex that federal legislation will have unintended consequences that may exacerbate the situation.

From my perspective, the law sets the stage for allowing real change to occur in the places that understand our health care delivery “non-system” the best: the providers of health care. That is to say, the people and organizations that provide health care every day are now in an even better position to achieve those key goals. They know how to lower the costs of medical care, they know how to elevate its quality, they know how to make it more accessible. That is not to say that this knowledge is widespread  and can be applied tomorrow. Rather, I mean that such knowledge exists in pockets across the US. With changes in health care financing, regulation, and information access, it should be possible to take what some know (and do) and apply those practices more widely in a reasonable period of time. The real changes won’t come from the government, but the government will be instrumental in supporting and disseminating those changes.

Count on the creativity and energy of the clinicians to make good things happen!

What kinds of changes am I talking about?  Stay tuned for my next blog.