Politics Be Damned: “5 Trends That Will Shape U.S. Health Care”

With election day upon us at last, we are all being deluged with projections as to who will be sitting in the White House come January. I have been watching this process from an emotional distance for at least the last month or so as the media reports the daily ups and downs of approval ratings, possible electoral vote scenarios and political reactions to the monster hurricane that just devastated parts of my city.

For a campaign in which candidates spent a total of $3 billion, the stakes are high for more than just individual issues like Medicare, unemployment, taxes, abortion and all the other hot button items that divide our country. If elected, Mitt Romney and the conservative base of the Republican party stand to fundamentally change the nature of this nation; sacrificing social programs, tolerance and federal responsibility to create a pro-big business, free-market country that cedes important federal powers to self-interested state authorities.

Of course we know how Gov. Romney and his erstwhile supporters in Congress feel about the health reform law. A long-time promise of the campaign has been to immediately repeal Obamacare, legislation Romney calls a “bad law.” He’s said that he plans to immediately grant waivers to all states, allowing them to ignore the law and stop work on setting up mandated health insurance exchanges. The next step is to use Congress’s  budget reconciliation process to repeal nearly all elements of the health law over the next several months.

There are  serious doubts, even among detractors of the ACA, that a Romney administration could successfully grant the state waivers and cut off funding for the health law. Federal courts are sure to get involved and block these widespread actions. Don’t forget that some popular aspects of the ACA–allowing young adults to stay on their parent’s health plans and requiring insurers to accept people with pre-existing conditions, for example–are already in place. It will be very difficult or impossible to use budget reconciliation to repeal these provisions, especially without an alternative plan in place.

That said, I believe there are key aspects of health reform that will continue to advance whatever the outcome of the election. These are the fundamental changes in how care is payed for and delivered that are already transforming our health care system. Several months ago, I was asked by Columbia University’s Mailman School of Public Health to write an article for a new magazine they were publishing. There have been many changes in Columbia’s  public health program and the resulting magazine conveys the breadth of  work done by researchers associated with the school and emphasizes a new “life course” approach to education that considers the influence of public health on every age and stage of life.

My assignment was to predict which aspects of health reform would prevail  if 1) the Supreme Court ruled that the ACA was unconstitutional, or the individual mandate was unconstitutional (it didn’t) or 2) Obama lost the election (as of today, still don’t know.). After many months and changing predictions, I agree with Michael S. Sparer, chair of Mailman School’s Department of Health Policy and Management who told me;

“There are important trends reshaping the healthcare system that will continue regardless of who wins the presidential election, who controls the next Congress, and whether the ACA survives or is repealed.” He continues in the article, “Indeed, while the ACA supports and encourages many of these trends, there simply is no going back. A healthcare revolution is under way.”

The five trends I chose to highlight include:

1) “Farewell Fee For Service, Hello Accountable Care”

2) “Playing Up Prevention”

3) “Rewarding Quality, Punishing Carelessness”

4) “Evidence Is the Best Medicine”

5) “Expanding the Reach of Medicaid”

I do point out that despite widespread adoption of innovative payment and delivery models  by Medicare and also by commercial insurers, there are serious barriers to reaching universal coverage without the ACA. It is vital that Medicare not be turned into a stingy voucher system, Medicaid be expanded and not made into a block grant program, and that all Americans be offered the chance to have affordable, high quality health coverage. It would be heartbreaking to come this far for naught.

Fingers crossed for tonight’s results; we still have a long way to go.

You can read “5 Trends That Will Shape U.S. Health Care (No Matter How the Politics Play Out” here in Columbia Public Health, and perhaps come up with your own predictions for the future of health care.