A newly published summary of changes likely to happen in the US health system as reform progresses. Evaluation of the effects of these changes on health care would seem to be a fertile area for health services researchers.
The Affordable Care Act and the Future of Clinical Medicine: The Opportunities and Challenges — Ann Intern Med
Since my days as a medical student in India, the Annals of Internal Medicine was a journal highly recommended by my professors, essential for enhancing the knowledge base of every medical student. I continue to hold the journal in high esteem and began reading the above referenced article, marvelling at the ‘textbook’ perfect plan to reform America’s healthcare system. However, as I extended my reading to the comments posted by the readers, I was in for a rude shock! The overwhelming, one-sided criticism of not only the plan, the article, the author, but also the journal itself (some readers even declaring that they would renounce their AIM subscription, some calling for the resignation of the AIM editors) was indeed worthy of note.
ReplyDeleteBeing a newcomer to the American healthcare system and oblivious to the politics behind it, I would like to believe that the plan holds great promise for reform. The basic tenets of the plan seem to have been borrowed from successfully implemented health systems across the globe. Why these tenets have met with severe cynicism in the American context becomes interesting for a novice to study. Till then, the commentary on the Act seems to have evoked thought among its readers, further discussion and debate on which will significantly contribute in shaping the healthcare system in America.
Caroline, you missed a heck of a fight over the past year regarding this Act. The responses and comments to the article are only the beginning. It’s definitely been an interesting process to watch.
ReplyDeleteWhile reform has been much needed and the Affordable Care Act does great things to improve accessibility to, and reduce costs of, health care for millions of Americans, there are plenty of others who fear any change, especially such large changes to something so critical as health care. Not to discredit such fears - to be certain, there are many as yet unanswered questions regarding how many reforms (such as expansion of Medicaid benefits) will be paid for in the long-term. This is especially disconcerting in the face of the ever-increasing national debt. I realize that arguments against increased spending don’t really appear in comments from the doctors that responded, but I just felt it might be helpful in giving you a feel for some of the contention that has arisen nationwide. However, their comments do reflect sentiments that seem to be held by many in the general public, in that there is a general fear of increased governmental control that will inhibit practitioners’ ability to practice medicine as they and their patients see fit. While some of their comments seem a bit harsh, the article itself does paint a rather rosy and optimistic picture of the new act without addressing many of the concerns that these doctors (and likely many others) have. Hopefully their criticisms will spawn additional literature that does take up some of the stickier aspects of the new health care law.
As a separate side note since you weren't in the states during the height of the health care debate, check out this recently aired piece from NPR to give you a taste of some of the other (more ridiculous) fears some Americans have regarding the new health care law: http://www.npr.org/templates/story/story.php?storyId=129581493
Thank you, Caroline, for pointing out the comments in response to this article, which I had previously missed. As Chelsea mentioned, this was just a taste of what the debate surrounding health care reform has been like.
ReplyDeleteI agree with Chelsea’s description of the original article as being too optimistic and painting too “rosy” of a picture, though I find it funny that the respondents to this article expected anything different from an opinion piece written by individuals from the Obama administration. Unfortunately, it seems a majority of the commentators spent their time and energy on accusations of AIM publishing "propaganda" rather than constructive suggestions for improvements. I think Chelsea is correct in attributing much of this criticism to fear of the unknown. In the NPR article she linked to, one gets a sense of the hysteria much of the public experienced during the year long debate over this legislation. Perhaps some of these fears should be expected as there are certainly many things about our health care system will change in the coming years as a result of the Affordable Care Act. However, I can’t help but think that many of these worries are grossly disproportionate to the scale of the changes the legislation could actually hope to bring about. After all, the health care system our country has been using for at least the past 40 years remains relatively unchanged. The Affordable Care Act only tweaks this system, making relatively minor modification. Despite the fact that this is the first major health care reform legislation to pass since the creation of Medicare and Medicaid and despite the grandiose rhetoric used by both sides of the political spectrum, the pending changes are far from a “complete overhaul” of our health care system. With that in mind, I would argue that the physicians who responded to this article should temper both their fears and their expectations. The passed legislation does not constitute a complete government take-over of health care, nor does it magically create a flawless system where doctors are able to practice without the burdens of complex billing and paperwork for a reimbursement rate which they always view as fair.