Supreme Court Ruling on the Accountable Care Act
Published on July 3, 2012
One thing should be clear after last week’s U.S. Supreme Court ruling. It’s time to end three-and-a-half years of political wrangling and make the Affordable Health Care Act (AHCA) work. The law’s shortcomings are well known. It provides health care access to 30 million people, but contains no viable funding mechanism for this $1 trillion mandate and no assurance of reversing the inexorable rise in health care costs. Paradoxically, although America has the most technologically advanced and expensive health care system in the world, its citizens continue to get sicker.
The reason for this paradox shouldn’t be a mystery. Our system focuses almost entirely on disease care to keep people alive, but does very little to enable Americans to live healthy lives. The longer people live in their disease-prone years, the more they cost Medicare. AHCA doesn’t really address these challenges. Unless we face them squarely, Medicare will ultimately be bankrupt, and Americans will be forced to pay for a much higher share of their health care bills.
There is a better way. The United States must make healthy living the 21st century equivalent of putting a man on the moon. With lifestyle choices accounting for more than 50 percent of health care spending, we should launch a decade-long national “Healthy Living” campaign focusing on nutrition, diet, physical fitness, and stress reduction. We cannot continue to ignore the obesity epidemic sweeping the nation — a serious situation that is leading to ever-increasing rates of diabetes; cardiovascular disease; cancer, spine and joint disease; and metabolic syndrome.
One of the most important aspects of AHCA is the creation of designated accountable care organizations (ACOs). ACOs shift reimbursement away from the prevalent fee-for-service model that measures inputs to focus on outcomes — keeping people well. These organizations will provide their members with the tools and teams of health professionals they need to stay healthy. ACOs will include not only doctors and nurses, but health coaches, nutritionists, physical trainers, and complementary therapists, all working together as an integrated team to provide acupuncture, meditation and relaxation therapy, massage, and yoga. These diverse therapies are equally important for people suffering from chronic illnesses in order to prevent recurrence of their diseases.
To make such a campaign work, Americans must take greater responsibility for maintaining their health. In the future they will have a health score, much like their credit score, that is based on well-established metrics that will motivate them to improve their health. Inevitably, they will also have to assume greater financial responsibility for the cost of their care, while abandoning the myth that “health care is free.” This will be accomplished through incentives for those who maintain their health, enabling them to pay less, while people who cost the system more will pay a larger proportion of their expenses.
Large employers as varied as Medtronic, Exxon, General Mills and Whole Foods, all of which are self-insured, have already moved forward with such systems, and their rewards are reflected in the lower cost of employee health care and higher rates of on-the-job employee productivity. Employers must lead the way in ensuring the health of their employees and their families by demanding more aggressive requirements from their health plans or they must work directly with large health systems.
At this stage in our nation’s history we face a clear choice. Continue with the current disease-based system with expanded access and watch as people get sicker and the country’s financial condition deteriorates. Or mount a massive healthy living campaign by focusing on prevention, wellness, and personal responsibility. In my view the choice is clear, and the time to act is long overdue.