The healthcare legislation that looks headed to the President’s desk is not ideal. It couldn’t be otherwise given our country’s deeply held and contradictory values. But the fact that tens of millions of Americans are uninsured and most of the rest of us are just one lost job from the same dilemma, drove this train. A majority in the Senate, and now the House, have decided they couldn’t lose another generation in pursuit of the perfect bill.
I studied with George Bugbee, (the American Hospital Association’s first non-physician executive director) to become a hospital administrator just a few years after the creation of Medicare and Medicaid in 1965. Assuring universal coverage for the rest of America was widely believed to be right around the corner. It has been a long corner.
It took us the greater part of twenty years to work through challenges caused but not anticipated when the Medicare Prospective Payment System began in 1983. It will take at least that long for all of us to digest this new change. From a rural perspective, here are some of the priority areas that will need our attention:Protecting access to local care is a high priority as we address the systemic changes this legislation will incentivize. Equally a threat to access is the soon to explode retirement of baby boomers, leading to worsening of the current mal-distribution of healthcare professionals.
Given the history of rural health voices being underrepresented on the current Medicare Payment Advisory Commission, an even more powerful Medicare Commission is potentially threatening to rural equity and will require even greater vigilance.
Health reform’s first installment was the American Recovery and Reinvestment Act and its focus on health information technology. Unfortunately, it appears that many decisions to date, by Congress and the Administration, are leading to an increase in the rural-urban digital divide.
The greatest limitation to this legislation is that it is about “healthcare” much more than about “health” reform. Americans are breaking the healthcare bank due to too much smoking, drinking and eating, and too little exercise, education and jobs. We must expand our efforts to help individuals and communities become healthier–to reduce the need for health care.
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I appreciate the historic view of what passed in the House last evening. It seems to be more of “insurance reform” than “health reform.” Let’s hope its but a start to achieve “health” reform. As Voltaire said, we shoudn’t let the perfect be the enemy of the good. Of course, he also said, “a witty saying proves nothing.”