After more than one year of bitter, partisan and often insipid fighting, the healthcare reform legislation that President Barack Obama signed last week is now the law of the land.
Get ready for the mother of all learning curves, as Congress—one of the nation's least trusted entities (along with bankers and journalists)—passes its handiwork to the nation's most trusted professionals–healthcare workers.
This is a daunting task. Simply by the nature of their work, and their personal contact with patients, doctors, nurses, and others, direct-care providers will be charged with explaining the intricacies of the most complex, comprehensive, and truly life-changing federal legislation since the creation of Medicare in 1965. Their patients will probably be confused, perhaps skeptical, or even frightened about how the new reforms will impact their care. This is completely understandable after more than one year of scare tactics and deliberate distortions about "death panels," killing grandma, and faceless Washington bureaucrats rationing care.
"The difference between the way the bill was fought legislatively and what is actually in the bill is enormous," says Frederick E. Turton, MD, an internist from Sarasota, FL, and chair of the Board of Regents of the American College of Physicians. "In fact, there are a lot of good things in this bill that make patient care immediately better, and the physician is going to have to carefully explain this to his or her patients on an issue-by-issue and occasion-by-occasion basis."
Patients might display their fear or confusion in the questions they ask. "Generally, the questions arise in a patient-doctor encounter when the patient says something like 'Please order this test before the government says I can't have it,"' Turton says. "In fact there is no rationing in this bill whatsoever. The most important part is that doctors and patients can see each other again because 94% of legal residents will have access to health insurance, and that is a big deal."
Turton concedes, though, that no matter how healthcare providers feel about these reforms, nobody really knows if they are going to work over the long run. "There are so many moving parts to this legislation and it kicks in over such an extended period of time that it is difficult--if not impossible--to say exactly how this is going to translate into practice," he says.
Understanding the reforms and how they impact patients will take time. "I believe a natural process would be a good way of describing it," Turton says. "The tenets of the bill will survive based on their merits. Secondary consequences will occur based on merits that we didn't understand. As time goes by we will understand this bill much more than we do now."
In the short term, however, Turton says the confusion over the new reforms will probably be worse than confusion he witnessed when Medicare Part D was implemented. "We really didn't understand that, and it took some while. In particular, with the donut hole, it took a lot of patients telling me 'please don't prescribe another medication because I am in the donut hole' for me to understand what that meant," Turton says. "And this bill is magnitudes of order bigger than Medicare Part D. It is going to take us much longer to figure out what the real consequences are."
What about those physicians, nurses and other direct-care providers who don't like the new reforms? How can they balance that discontent with their responsibilities to their patients? Turton isn't worried.
"They will do what they have always done, which is take care of their patients, and use the resources available to them in the best way they can to take care of their patients," he says. "Politics is one thing, but taking care of people is quite another."