A Perspective on the U.S. Supreme Court Decision on Health Care

By Tej Maini, MD

It is unrealistic to expect that the recent U.S. Supreme Court’s 5-4 ruling upholding most of President Obama’s health care proposal, also known as the Affordable Care Act (ACA), will have any impact internationally. However, here are a few facts about health care in the United States…

  • America is the only industrialized country in the world that does not offer health insurance to all its citizens
  • Approximately 50 million American’s do not have any health insurance; a staggering number
  • Perverse incentives exist for doctors to perform more procedures and tests in the fee-for-service sector, also resulting in an incredible amount of wasted resources
  • People with health insurance are completely segregated from those without
  • For the first time penalties such as no payments to hospitals and physicians for readmissions have been put into place
  • The measurement of quality and patient safety and the positive incentives in the ACA that accompany it, are noteworthy
  • Although perceived as being bureaucratic, the Joint Commission for the Accreditation of Hospital Organizations (JCAHO), and the Joint Commission International (JCI) have placed patient quality and safety as a foremost priority
  • Physicians, health insurers and hospitals are scrambling to work together to improve the outcome of care that is provided to patients that they serve. The success of pilot studies undertaken by Accountable Care Organizations (ACOs) is commendable. What remains to be seen, however, is who will pay for the infrastructure that is needed for these ACOs to be fully operational and effective.

Emerging economies and those countries that are in various stages of providing health care to their constituents have a lot to understand from the lessons that are being learnt in the U.S.:

  • Every country’s citizens should have health care as a right
  • Health insurance should be easily understood by everyone
  • Every insurer should have the same forms for hospital, pharmacy and physician reimbursement
  • The income disparity between Primary Care and Specialty Physicians must be narrowed
  • Tort reform should be undertaken: it is time that we spoke up to lobbying groups such as the Trial Lawyers Association
  • All Electronic Health Records should be similar and the data that needs to be extracted should be easy and transparent for physicians, insurers and hospitals
  • There must be incentives for physicians and hospitals to practice high quality medical care. Those not performing up to standard must change or be weeded out.

Only then will the provision of health care be fair, and hospitals, physicians and above all, the patients will receive high quality, affordable health care.

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