Summer 2012 - Western University of Health Sciences

needs. But only 24 percent believe the system meets the needs
of most Americans.
“This is the paradox of reforming health care,” Benner said.
“We all think the health care system meets our needs well, but
we mostly all express frustration in how it meets the needs of
other people. Imagine trying to make policy in this
environment.”
The Brookings Institute, a nonprofit think tank, convened
leading health economists to come up with health care reform
recommendations. Their suggested steps to reduce health care
spending growth and improve quality include:
• Invest in better information and better tools for measuring
and improving care.
• Restructure some of the inefficiencies in the insurance
market.
• Transition to accountable payment systems, which means
paying health care providers and clinicians based on the
value they deliver, not for volume of service.
• Provide direct support that would encourage better
individual choices by patients.
The Affordable Care Act (ACA) includes some of these
recommendations. It establishes a mandate that most legal
residents in the U.S. need to buy health insurance or pay a
penalty. It creates insurance exchanges through which certain
individuals and families may receive federal subsidies. It
significantly expands eligibility for Medicaid, and includes no
fewer than 45 reforms aimed at changing how health care is
delivered, Benner said.
Two years after it was signed into law, the ACA looks
primarily like a coverage expansion bill with new rules about
how insurance markets work, Benner said. The same experts
who suggested how the bill should look said it is helpful, but
is not enough to bend the cost curve and ensure high-quality
innovative care gets to everybody who needs it, he said.
The U.S. Supreme Court is determining whether the individual
insurance requirement, or mandate, is constitutional. Benner
said he doesn’t know how the Supreme Court will rule, but
change is coming regardless.
“No matter what happens with the Affordable Care Act,
health care reform will continue because it has to,” he said.
“We have a lot more work to do. Real health care reform has
to happen.”
He concluded by giving students advice as they continue their
training and begin their careers.
“It’s important as a health professional to keep an open mind
and embrace … change,” Benner said. “Recognize that it’s
healthy and it’s needed. View changes like the Affordable Care
Act and other changes to law or policy as opportunities to
improve health care.”
This health care system students are entering is going to
reward professionals who seek accountability for patient
outcomes and cost, he added.
“Take responsibility for that patient. If things go well, you
benefit. If things don’t go well, you’re on the hook. That’s
what accountability means in the health care system of the
future,” Benner said.
Part of what’s happening in health care is a shakeout to
determine who is going to be accountable for the quality and
value of care in our country.
“As you finish your training and move on into practice,
engage in and think about the health care system at all levels
— the ‘sausage making,’ the policy, the politics,” Benner said.
“Ask yourself once every year, ‘What am I doing to improve
health care’ And if you don’t have a good answer to that
question, find one, and work for it. Because the health care
system of tomorrow will reward you for it.” ■
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