A Reader Responds to Let Them Eat Cake

The Disease Management Care Blog is happy to post thoughtful rejoinders from readers.  This is one from Joe Morris, who remains a health policy observer, having migrated from an early policy background as manager of the NJ DRG case mix payment project and Assistant NJ Health Commissioner to executive positions with hospitals and healthcare trade associations.

In this October 7 "Let Them Eat Cake" posting, the DMCB argues that the entire health care system is not ailing and that not all of it needs to be fixed by the Affordable Care Act.  Outside its identification of the broken individual market, however, there were other segments that were troubled, including the widespread practice of excluding pre-existing conditions as well as the ability of insurers to land windfall profits from withholding medical care.  All warranted some statutory or regulatory intervention. 

That being said, implementation of anything as complex as health reform is bound to be complicated. It makes sense to set priorities and roll out health reform so that the more important parts come first.  A good local non-healthcare example was the implementation of EZPass, which had its share of start-up problems.  It wasn’t rolled back and it’s since been quite successful.

Too bad that the ACA continues to be bedeviled by a lack of stakeholders who want to constructively reconcile public health needs and needed revisions of the ACA without the negative influence of politics.  Perhaps one solution is to get the elected leaders out of the mix and turn to clinicians who have real insights about their patients needs.

On the other hand, removing politicians has its own risk, since government involvement in health care is here to stay.  What’s more, they did a good job with Medicare and no one, other than a radical fringe, is proposing that that program be defunded, repealed or replaced.