23 Mar 2010

Robert Huckman on the Passage of U.S. Healthcare Reform Legislation

Robert Huckman Photo: Stuart Cahill

Robert Huckman
Associate Professor of Business Administration and Faculty Research Fellow in the health care program of the National Bureau of Economic Research.

This Patient Protection and Affordable Care Act approved by Congress and signed into law this week is indeed historic. Most notably, it promises to eventually expand coverage to an estimated 32 million uninsured Americans and takes important steps in limiting the ability of insurers to deny coverage to patients with pre-existing conditions. This legislation is by no means perfect, but the question we need to ask is whether significant reform of the American health care system can be better achieved by "passing and fixing" this bill than by "keeping and fixing" the current system. The prospects for the former strike me as better than those for the latter, but I must admit that the jury is still out.

The good news is that the bill tackles many important issues related to insurance coverage. The more sobering news is that addressing coverage issues shines a bright light on the more fundamental reform that still needs to occur--improving the process by which medical care is actually delivered to patients. There has been much discussion about the critical and remaining need to study the cost-effectiveness of various approaches to treatment to get a better sense of what does (and does not) create value for patients. Not only does cost-effectiveness need to be studied, but clinicians and patients need to begin to act on the lessons emerging from those studies. In the end, meaningful reform of the care-delivery process is difficult to legislate, as it requires education, persuasion, and behavioral change at the level of individual clinicians, administrators, and patients.

I hope that the bill passed by Congress has initiated a process that will ultimately improve the American health care system by making it not only more accessible but also more efficient and effective. That said, it is important to acknowledge that the bill is but one step along the path to more fundamental reform.

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