As the U.S. Supreme Court prepares its decision on the landmark health care reform law, conversations about health care are happening just about everywhere, from the grocery store to the corner café, in big cities and in small towns. And the reason is simple:
"Health care in America is now unsustainable," says Don Berwick, former administrator of the Centers for Medicare and Medicaid Services. "What we know is health care can be a lot better than it is and lower cost by changing health care to be more responsive to patients.
Berwick became Medicare chief just six months after the Obama Administration’s health reform law passed. During his almost 18-month tenure, he implemented many of the earliest provisions of the Patient Protection and Affordable Care Act, including coverage for those with pre-existing conditions, and the introduction of no-cost preventive care — such as check ups, cancer screenings and immunizations — for Medicare patients.
Berwick is among many leaders in the health care field who believe reform is now on a trajectory that won’t be stopped, no matter the justices’ ruling.
“Whether that law survives or not, the ship has left the port," he says. "There’s so much change in this country, in the private sector as well as the public sector. Doctors, hospitals, nurses – everyone knows that care needs to change to better meet the needs of patients.”
Joel Hay, a professor at the Schaeffer Center for Health Policy and Economics at the University of Southern California, agrees. He points out that medical costs now devour 17 percent of our Gross Domestic Product. Put another way, those costs have consumed all pay increases given to working-class Americans during the past two decades.
"The average American is not gaining ground in terms of take-home pay precisely because health care costs are out of control," says Hay, who opposes the Affordable Care Act as too unwieldy and complex. Instead, he proposes a different plan:
"Instead of having an enormously complex plan that is run out of Washington... we (should) allow the states to experiment on their own. Let them take charge of their own systems to figure out something that will work a lot better."
Governor Edmund G. Brown, Jr.'s administration says that’s exactly what it plans to do should the Supreme Court deem the federal health care law unconstitutional. However, the shape a California health care plan might take isn't yet clear - especially in light of the state’s $16 billion budget deficit.
Still, the fact these discussions are even happening is moving reform forward.
"One of the things that strikes me: While there’s a lot of political controversy, there is almost no disagreement among people — Republicans and Democrats — who are involved in the health care system about where we need to go, what the tools are to get there and everybody is working on it,” says Micah Weinberg a political scientist and senior policy advisor to the Bay Area Council, a business-sponsored public policy organization in San Francisco.
A few examples Weinberg cites: employers — large and small — are focusing on purchasing health care in more economical ways. Doctors are redesigning their practices to offer more team-based, patient-centered care; and financial incentives are prompting hospitals to become more efficient by making changes such as reducing costly hospital re-admissions.
All are just some of the changes that won't be stopped even if the Supreme Court overturns the Affordable Care Act.
“We can make health care exactly what it needs to become," says Berwick. "We can get out of this crazy system that just pays and pays and pays for more and more things without value to patients... quality will go up. Patients will be better off and costs will fall.”
The Supreme Court is expected to render its opinion on the constitutionality of the federal health care law before the end of the month.