At long last it is now the official policy of this country that all Americans have access to healthcare regardless of circumstances. And we have put this country on a path to control costs and improve the quality of healthcare in America.
First and 10
But there's still a long way to go to cross the goal line
Congratulations to President Barack Obama and his team for their extraordinary leadership and persistence in achieving something that his predecessors could not. In addition, House Speaker Nancy Pelosi (D-Calif.), Senator Majority Leader Harry Reid (D-Nev.), and the courageous members of the House and Senate who supported this bill demonstrated remarkable leadership while withstanding immense political pressures to do what good governance required.
However, after 15 months of historic legislative effort that included countless meetings, innumerable congressional hearings, many difficult votes and thousands of speeches, this is only the beginning.
In fact, if this were a football field, we would be only first and 10 on the 30-yard line with 70 yards to go. This landmark legislation now gives us the opportunity to move the ball toward the goal line of universal access, reduce cost through meaningful payment reform and significantly improve health quality and outcomes.
After the incredibly heavy and unprecedented lift of legislating, the challenging and time-consuming task of implementation must now commence. It includes substantial reform of our insurance market, embryonic efforts to reform the way we pay for healthcare, and initial policy investments to improve healthcare delivery. It is critically important to apply these new policy tools to address our current circumstances and give priority to the problems we must solve.
As a result of the close cooperation and coordination among congressional leaders with key officials in the White House and HHS, this challenge is well-understood. They know we must use the full authority of this legislation to aggressively begin comprehensive and expeditious implementation.
My hope is that the Obama administration and Congress will work closely with all healthcare stakeholders to maximize the positive impact of health reform and minimize disruption. And as they do, they must make a concerted effort to use their newfound legislative authority to ensure the following five enacted goals are their highest priority:
First, after the economic stimulus legislation last year, this is the second critical legislative achievement in this Congress that advances the implementation of health information technology. In many ways, health IT represents the very heart of transformational health practices. Currently, we have the benefits of a 21st-century operating room but are saddled with a 19th-century administrative room. Only by moving into the 21st century administratively and medically can the rest of reform be accomplished.
Second, the new law calls for far greater transparency in our healthcare market. Healthcare is the most opaque of all sectors in our economy. It is virtually the only sector where at the time of purchase we don't know who will pay or what it will cost. Sadly, we have more statistical information on every sports figure in America than we do on providers, institutions or local healthcare markets. Beginning now, if implemented aggressively, pricing, performance and far more consumer health information can be the new reality.
Third, the new law provides tools to eliminate unnecessary medical care at all levels. Much of it results from our fee-for-service reimbursement policies. We must cease rewarding the volume of care and instead offer incentives for its value. In addition, we must not take away incentives for the practice of proprietary medicine and market-driven care. We also need a healthcare delivery environment that addresses defensive medicine by allowing providers to be advocates rather than adversaries when medical mistakes are made, while also adopting innovative ways to compensate patients. This legislation puts us on a path to do that. Finally, once greater transparency is achieved, far more work needs to be done to eradicate pervasive fraud and abuse in both the public and private sectors of our healthcare marketplace.
Fourth, healthcare is like a pyramid. Preventive care and wellness promotion occupy the base. As one ascends, healthcare becomes more sophisticated and technological with heart transplants and MRIs at the top. While every country starts at the base and works up until resources run out, we start at the top and work down until resources run out.
By reallocating resources through the elimination of unnecessary care, the law provides an opportunity to cover our healthcare pyramid from top to bottom. While it would be nearly impossible to invert it and relinquish our worldwide leadership in research and technology, by addressing the priorities above, we should have ample resources to cover all our healthcare needs from top to bottom.
An emphasis on wellness, however, cannot simply be a responsibility of our healthcare marketplace. It is also an individual and community responsibility. And we must strive to make good nutrition cool.
Fifth and finally, this country must encourage best practices. We must destroy the myth that we have the best healthcare system in the world. Americans deserve better outcomes. Readmission rates must come down. Infection rates are unacceptable. And the number of injuries and deaths from medical mistakes are an embarrassment to this country.
Coordinated care for chronic illness, evidence-based medicine—beginning with universal utilization of simple checklists, along with comparative research and best practices—work. Look no further than some of our finest health institutions for proof. The new law helps the rest of healthcare in America to follow suit.
First and 10 on the 30-yard line is an unprecedented and historic achievement. It will take leadership, teamwork, an emphasis on these priorities, coupled with a lot of luck and great effort, to reach the goal line.
But at long last we are now on the field.
Tom Daschle is a former Democratic senator from South Dakota.
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