What the Reform Law Fails to Reform

Under the pilot programs that have been enacted, such as value-based purchasing rules, ACOs, and Medicare reform pilots, "it would take 15 years to change the payment model," he says.

One of the many problems with healthcare costs reflect the lack of coordination of care and the duplication of services that result, in part, from the fact that many healthcare providers bear little to no responsibility for efficiency, even now, said Geisinger Health System President and CEO Glenn Steele, in an interview conducted prior to the court's decision.

That lack of responsibility is not the case for health systems that include a payer function, such as Geisinger and many other health systems the Obama administration holds up as examples of efficient care delivery.

For its part, Geisinger has made big investments in reducing waste and duplication and increasing transparency. It spends a whopping 4.5% of its annual revenue on maintaining and improving its data warehousing capability, for example. Though a huge number, that investment pays off for institutions like Geisinger, which make up only a fraction of the healthcare provided in the United States each year. Other healthcare providers, including physician practices, hospitals, and health systems, have little in common with Geisinger, and Steele knows it.