Editorial: Health care reform must be basis of better system

In the past decade, the health care landscape has shifted dramatically, with the exclamation point being the passage of the Affordable Care Act. But the transformation will be a failure if health care costs aren’t contained and quality isn’t improved.

Reporters John Webster and John Stucke captured the changes that are to come and those already under way with last week’s in-depth reporting. It’s a complicated issue, but the fate of health care delivery statewide and in this region hangs on the outcome.

The battles of hospital systems, clinics and insurers are an outgrowth of the tremendous amounts of money tied to health care. No other nation spends as much as ours on health care, so no other nation offers as much incentive to get in on the action. About one-third of health care spending is unnecessary, but that waste generates huge profits. The challenge is to reduce waste while making health care accessible and affordable.

If reform is viewed as the foundation on which to build a better system, then it might leave a positive legacy. But if it’s viewed as the finish line, we will continue to be saddled with a bloated, inefficient system that gnaws away at household and government budgets.

The good news is that little green shoots of progress have been spotted.

The Congressional Budget Office reported last month that health care inflation has stalled. This slowdown was initially dismissed as a reaction to the Great Recession, but as it persists more health care experts say it could be tied to changes in health care delivery. The CBO noted that some of the changes predate the passage of the Affordable Care Act, and the recession.

More doctors have been put on salary. Fee-for-service is on the decline. Hospitals are emphasizing follow-up care to cut down on readmissions. There is greater coordination of care for patients with chronic conditions and greater emphasis on disease prevention. As health care becomes more accessible, more of it will be moved out of emergency rooms and into the hands of primary care physicians.

The Affordable Care Act has some incentives to encourage these positive changes, but the reforms are still too timid. Our leaders have danced around what should be covered and what shouldn’t. It’s time to stop the music and make the difficult choices. Other nations made these decisions long ago, which is why they spend much less on health care without hurting patient outcomes.

Patients also need to change their attitudes and expectations. To date, the chief concern has been who will pay, rather than, “Why does it cost so much?” Or, “Do I really need this?”

It’s been a misnomer to discuss the U.S. health care “system,” because it suggests we’ve had a plan. Reform hasn’t fixed this, but it has given us a vision of rational care to pursue.

In this landscape, it’s best to take the long view.