Understanding Health Care Reform ─ Bridging the Gap Between Myth and Reality

After nearly a year of debate, in March 2010, Congress passed and the president signed the Patient Protection and Affordable Care Act to reform the U.S. health care system. The most significant social legislation since the civil rights legislation and the creation of Medicare and Medicaid, the bill’s passage has been met with great controversy. Political pundits, politicians, health care economists, and policy analysts have filled the airwaves and the lay press with their opinions, but little has been heard from those who have the most invested in health care delivery reform—patients and their doctors.

Understanding Health Care Reform: Bridging the Gap Between Myth and Reality provides readers with the information to make informed decisions and to help counter the bias of political pundits and the influence of the for-profit health care industry. The author introduces readers to a group of dedicated doctors, administrators, and patients whose experiences illustrate the strengths and weaknesses of the health care reform legislation. He also shares his own experiences as both a physician and a patient. The book puts the health care reform legislation in perspective by exploring ten critical areas:



The private insurance industry
Medicare and Medicaid
The elimination of waste caused by overutilization, high administrative fees, and fraud
Disease prevention and wellness programs
Care for the underserved—the health care "safety net"
Quality of care
The impending workforce shortage
Comparative-effectiveness research to compare treatments
Changes in the way medicine is practiced
Tort reform


Describing the reform act as the foundation and framing of a house, it outlines what doctors, patients, and families must focus on as states, the federal government, and the courts craft this legislation over time. The author cuts through the political rhetoric to address the core question: how do we preserve our ability to provide the best possible care for patients and fulfill our societal mission of providing care for our citizens independent of their financial means? Focusing on strengths and weaknesses, rather than what is right or wrong, he encourages readers to think creatively about their role in establishing a better system of health care in America.

Arthur M. Feldman, MD, PhD, is the Executive Dean at the Temple University School of Medicine.

IntroductionReforming the Private Insurance IndustryThe Private Insurance Industry in the United StatesReforming the Private Insurance IndustryFlaws in the Patient Protection and Affordable Care ActStrengthening the Health Care Reform LegislationNotesHow Will Health Care Reform Affect the Medicare and Medicaid Populations?About MedicareHow Does the Health Care Reform Legislation Change Medicare and Medicaid?The Independence at Home ProgramMedical HomesAccountable Care OrganizationsThe Extension Program HubCommunity Health CentersLowering Medicare and Medicaid CostsState Governments and Medicaid-Medicare ReformLowering Health Care Costs through Health Care ReformNotesCan We Lower Health Care Costs by Eliminating Waste?Medical Waste and Economic WasteCost-Benefit AnalysisControlling Medical and Economic WasteMedical Spending in the Last Days of LifeThe Patient Protection and Affordable Care Act and WastePlacing the Burden of Cost Control on the PatientPlacing the Responsibility for Decreasing Waste on HospitalsUnintended Consequences of Attempts to Eliminate WasteDeveloping a Rational and National Strategy to Reduce WasteNotesThe Role of Disease Prevention in Health Care ReformPrevention and Wellness Programs in the Patient Protection and Affordable Care ActSection 2705 of the Patient Protection and Affordable Care Act—Legislating Wellness!The U.S. Preventive Services Task Force: Another Potential Flaw in the Patient Protection and Affordable Care ActPrevention Doesn’t Lower Health Care Costs—It Might Actually Increase Them!Addressing the Epidemic of Obesity—And Health Care ReformIndividuals Must Often Support the Costs of PreventionSteps to Ensure Prevention and WellnessNotesHow Will Health Care Reform Affect the Medically Underserved and the Safety Net Hospitals That Care for Them?The Health Care Safety NetThe History of Safety Net HospitalsDisproportionate-Share Hospital PaymentsSafety Net Hospitals Falter When DSH Funds Are Redirected to Pay for Health InsuranceThe Patient Protection and Affordable Care Act Threatens the Country’s Safety NetPay-for-Performance Can Also Threaten Safety Net HospitalsThe Health Care ExchangeWill the Exchanges Work?Some States Are Ahead of the Curve—Others Behind ItHealth Care Reform in Massachusetts: A Template for Health Care Exchanges?How Can the Patient Protection and Affordable Care Act Be Modified to Protect the Safety Net?NotesHow Can We Improve the Quality of Care in the United States?The Cost-Quality ConundrumThe Dartmouth Atlas and Health Care ReformMeasuring Quality of CareMeasuring Quality of Care: The Health Care Reform LegislationPay-for-PerformanceThe Electronic Health RecordValue-Based PurchasingSubstantive Steps Taken by the Patient Protection and Affordable Care ActWhat Additional Steps Should Congress Take to Ensure Quality of Care?NotesWill There Be Enough Doctors to Care for 35 Million New Patients?How Does the Patient Protection and Affordable Care Act Address the Workforce Crisis?The 1997 Balanced Budget Act and the Health Care Workforce CrisisThe Changing Demographics of the Physician WorkforceThe Workforce Crisis Is Not in Primary Care AloneLessons from MassachusettsHow Have We Approached the Need to Increase the Number of Practicing Physicians in the United States?Danger around the CornerWhat Should We Do to Increase the Size of the Health Care Workforce?NotesCan Research Guide Us to Improved Care at Lower Costs?Why Comparative-Effectiveness Research Has Become a Lightning Rod in the Health Care DebatesThe Patient Protection and Affordable Care Act and Comparative-Effectiveness ResearchThe Potential Value of Comparative-Effectiveness ResearchCan Comparative-Effectiveness Research Lower Costs?Limitations of Comparative-Effectiveness StudiesUsing Comparative-Effectiveness ResearchNotesHow Will Health Care Reform Change the Way We Practice Medicine?Physician CompensationThe Sustainable Growth RateHow Did the Patient Protection and Affordable Care Act Change the Way Doctors Are Paid?Pay-for-PerformancePayment BundlingGlobal PaymentElectronic Health RecordsMultispecialty Group PracticesThe Independent Payment Advisory BoardHow Can the Patient Protection and Affordable Care Act Be Improved?NotesWill We Ever See Tort Reform in the United States?The Current Tort SystemMalpractice CapsThe Patient Protection and Affordable Care Act Failed to Address Tort ReformMedical Malpractice—A Silent DiseaseEmployment Law and the Health ProfessionsIt Is Not Too Late—Novel Strategies for Reforming Our Tort SystemNotesConclusionSurviving Health Care ReformNotesIndex