The Accountable Care Act Turns Two! Thoughts on an Anniversary

As a preventive medicine, public health and health policy-trained family physician from a rural community, who has worked with underserved folks for nearly 25 (yes, really!!) years, I have to share this infographic. The Accountable Care Act is not perfect, but it moves us toward more equitable distribution of health care, provides for cost reductions, quality improvement, increased access and maintains our capacity as a nation to lead the world in health care innovation.

The fundamental problem is that we are no longer able as a society to pay for all the things we can DO in medicine, and we are struggling to come to terms with that.

If the ACA goes away, all the things in this graphic will go away. If the mandate goes away, the whole thing falls apart, because the insurance companies won’t play.

For those who are NOT celebrating the two-year anniversary of the ACA, I would issue a polite, but firm, challenge: Design a program, using public policies you can agree with, that would achieve these things. I have seen no other such proposal anywhere; absent one, I will support the ACA, and yes, celebrate it!

INFOGRAPHIC: The Affordable Care Act Turns Two


Today, I posted this, my most political post ever, to Facebook. With some trepidation. I know those who follow me on Facebook are made up of a number of folks who probably disagree with the premise; I know some of them will respond negatively. But I firmly believe that our current “status quo” in health care is not a “health care system,” but a “disease care industry.” I also firmly believe that the moral decision that over 50 million human beings who live in the richest country on the planet should be excluded from access to the most basic of health care is a hideous and unethical choice we have made for over 30 years. I believe these things to be unacceptable to me as a human being.

The political winds blow in many directions, and a lot gets lost in the crosswinds. The bottom line is, more people have more access, and costs are going down, and quality is going up (yes, physicians are being held accountable for the health of the populations they serve, and so are hospitals, health systems, educational institutions, and perhaps even politicians). This law has many things that need to be tweaked, and if it survives the Supreme Court challenge that begins week, many of those issues will be addressed, hopefully in a bipartisan fashion. But the ACA provides forward motion that leads to more people being able to afford basic health care, improvement in the quality of that health care, and more concern for the experience of patients, who are, in fact, a primary reason the industry exists – all of this is good.

Two years ago last week, I was in Washington, DC on the day the law was signed. I found myself in Washington again over the weekend, and was glad to be there for the second anniversary.


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