Why Healthcare Reform is a Big Deal

When my father started getting sharp, shooting pains in his head and neck last fall, he tried to just tough it out. That's basically how he handles most health problems. It can be a dangerous waiting game to play—the possibility of something serious like cancer or heart disease always looms in my mind—but he has few other options. He doesn't have health insurance.

Luckily, his eventual trip to the emergency room revealed a bad case of shingles and nothing more severe. But with no primary care doctor and no insurance, the emergency room is his only real source of care. Even that he only uses that when absolutely necessary. I remember him seeking medical treatment only a few times in my life, the last being an emergency hernia operation several years ago.

It's not that he doesn't want health insurance. He can't afford it—as a self-employed entrepreneur he was hit early and hard by the downturn. Like millions of Americans, he has had to choose between health insurance and other necessities like food and shelter, and lives one medical emergency away from financial disaster.

Cynicism about healthcare reform comes easy these days, especially after a solid year of hyperbole and bickering. When politicians talk about expanding access to 32 million Americans, most just hear that as another number in a litany of statistics.

But I personally know one of those 32 million whose prospects for real medical care improved with the stroke of President Obama's pen this week, and so does every physician who provides uncompensated care or spends time in an ED.

This is why what happened this week matters and why Vice President Joe Biden emphatically referred to it as a "big . . . deal" (with Biden's own kind of emphasis). Not just because of the opportunities it opens for people like my dad, but also because the next time Denver Health sees him, he will hopefully have better means to pay for care, and even follow-up with primary care physicians and specialists outside of the emergency room.

As long as I have been writing about healthcare, physicians have been sharing with me their frustrations about the number of uninsured in the country. Doctors not only struggle financially because they often provide uncompensated care, but many also are morally uncomfortable with a system that excludes so many people. Expanding access to insurance is important because it will help these patients get the right kind of care, which should be both cheaper and better quality in the long run.

Was the final healthcare reform package all that it could and should have been? Far from it. There is still a lot left undone in the areas of cost and quality, as well as preparing for an influx of newly-insured patients.

But those who aren't simply grinding a political axe will find reasons for optimism even on those fronts. The Medicare payment board opens a path for changing the reimbursement system to reward quality instead of quantity. Several CMS demonstration projects are testing new ways to align hospitals and physicians for better and cheaper care. Investments are being made in HIT, comparative effectiveness research, primary care, and other fundamentals of a strong healthcare system.

Somehow a moderate and incremental piece of legislation emerged from a bitterly partisan political process (in substance, it is essentially a Republican bill passed by Democrats). But it is best to think of it not as the end to healthcare reform, but an important first step. Given the historical struggles to pass reform, more like a giant leap.

Before even knowing who the candidates would be, HealthLeaders editors reserved a spot for the 44th president of the United States in our November 2007 HealthLeaders magazine story about "20 People Who Make Healthcare Better."

"We are holding a spot for a purposeful, studied and impassioned driver of ideas that will change fundamental cracks in healthcare funding and quality," wrote editor Jim Molpus more than three years ago. "We hope this man or woman will understand the inalterable relationship between our future prosperity and our nation's health. We are hopeful our next president understands the urgency."

While some disagree with his approach, few can claim that President Obama doesn't understand the importance of the healthcare system or the urgent need to fix its many problems. Since assuming office he has made healthcare reform his top priority, beginning with incentives in the stimulus package to jump start electronic health record and comparative effectiveness adoption, and continuing with an unprecedented expansion of access.

Hopefully that focus will continue, because the real work is only getting started. And hopefully politics will stop being such an obstacle to solving the real problems that remain. Because contrary to the ugliness of the last year, reforming healthcare ultimately isn't about ideology or which political party wins or loses or getting all or nothing in one fell swoop.

As the best physicians will tell you when asked about the reason they got into medicine, it's about the patients. And for patients like my dad, the legislation passed this week means access to potentially life-altering medical care for the first time in their lives. For millions more, it means pre-existing conditions or losing a job no longer preclude them from the system. And it means over time, uncompensated care will fall down the list of problems that keep physicians up at night.

That really is a big deal.

Note: You can sign up to receive HealthLeaders Media PhysicianLeaders, a free weekly e-newsletter that features the top physician business headlines of the week from leading news sources.