As we approach the election this fall, it seems like the news media report on little else. Unfortunately, too little news coverage addresses health care reform. This is ill-advised because there is still much to be done to improve the cost, quality, and access for patients within the US health care system. In this post, I will attempt to cover most of the major issues related to health care coverage that US consumers face.
In a previous piece I wrote for the JAMA Forum, just before the last presidential election, I discussed how health care reform is all about tradeoffs. For example, one way to make an insurance plans cheaper is to offer narrow networks (reducing access to high-cost services or allowing access only to physicians who agree to accept lower payments in return for the promise of higher volume). That’s a tradeoff. Community ratings and government regulation lead to improved access for some but fewer options for carriers (worse access). Weak mandates allow for more freedom in deciding whether to purchase insurance but lead to increased rates for others and fewer carriers participating.
We should not lose sight of what has improved. An additional 20 million US residents who lacked health coverage are now insured. Spending has slowed to below what was predicted. But there is still much work to do. Calling for blanket repeal of the ACA and a return to the status quo is not an improvement. But failing to recognize shortcomings in reform and working to ameliorate them would be a failure as well.
HENRY KOTULA 