Reforming Health Care

Afraid you or your loved ones might someday face a government death panel? Forty percent of Americans still believe in it. Sixty percent think healthcare reform will create a government run health plan.  (Kaiser Family Foundation)

 I’m not an expert, but I know these are myths about healthcare reform. I joined about 100 others this week to hear Jonathan Gruber, one of its architects, explain the national healthcare reform legislation known as the Affordable Care Act (ACA). Gruber has recently published the comic book “HealthCare Reform: What it is, Why it’s Necessary, How it Works.”

Gruber said he decided to publish in this illustrated form after his 17-year-old son and his publisher persuaded him. “When you’re on a plane and they want to teach you what to do in case of accident, they hand you a graphic. I think it was the right call,” he said.

Few if any in this San Francisco audience needed to be convinced that reform is necessary. But questions remain about how it will work.  Economists like Gruber define the primary problem as the soaring rate of increase in healthcare expenditures. The Affordable Care Act includes policies to slow the growth of healthcare spending:

• fighting fraud
• $33.7 billion per year in combined federal and State funds is paid inappropriately through Medicaid (HHS)
• better coordination of care
• preventing disease and illness before they happen
• creating a new state-based insurance marketplace

About 72 percent of surveyed Americans know that subsidies will be available to help low and moderate income citizens purchase the (mandated) health insurance.

Yet even Gruber admits that “cost control is too hard for us to know what to do right now” because of both scientific and political realities.  To make progress toward true cost control the bill funds pilot projects and encourages studies such as head-to-head comparative effectiveness examinations of treatment options. In the semi-regulated world of free market pharmaceuticals, comparative effectiveness is rarely studied.

Gruber’s entertaining presentation lasted precisely one hour, including audience questions. For further information, he frequently referred the audience to the site of the Massachusetts health insurance exchange. His book refers readers to The Kaiser Family Foundation, Commonwealth Fund and US Department of Health and Human Services:  www.healthcare.gov.