June 28, 2012--A Day in History

June 28, 2012…..will this become a landmark date within the history of our country?  Perhaps not, but as I pause to collect a few thoughts for Unum Vox, it is hard to take one’s eyes off of CNN, or the explosion within the blogosphere, over today’s Supreme Court ruling relative to the PPACA (Patient Protection and Affordable Care Act).  Without a doubt this is a critical moment in our country’s lurching, ponderous journey towards universally accessible, affordable, safe and reliable health care.  Rest assured, the political debate will only escalate, pundits will continue to pontificate, but a stake has now been placed firmly in the ground, and any effort to diminish, augment, or change our approach to health care reform will have to travel through this historic piece of health care legislation, or at least be measured by/compared to it.

Regardless of an individual’s political or philosophical persuasion, the PPACA pushes this country in several positive ways.  In fact, many laudable accomplishments can already be attributed to it.  The misfortune of severe illness no longer renders an individual uninsurable.  “Pre-existing illness” will disappear from the insurance industry’s lexicon.  Young adults will continue to be able to access the benefits of family coverage rates until age 26.  Through exchanges, employer based plans, and expanded Medicaid coverage we should be able to approach fully accessible health care for 95% of all citizens, and simultaneously remove a long standing embarrassment for this country amidst the roll call of nations within the developed world (even many countries considered to be “third world”).

Admittedly, this piece of legislation was/is far from perfect.  Much of the “tough medicine” true reform requires was side-stepped by our political leaders.  Sustainability is only possible within the context of affordability, and most will agree that the measures taken within the PPACA fall far short of dealing with the difficult decisions needed to take control of the inexorable climb of health care costs.  Until we hard-wire care that is fully cost conscious, and high value, this effort will collapse under its own weight.

However, I take great solace and daily inspiration from two critical observations by Dr. Donald Berwick, past director of CMS, and founder of IHI.  First, he likened the journey towards high quality, safe and reliable health care to a car trip, and he stated that the health care community (i.e. not Congress) drives that car.  Secondly, he opined the following:  “the key to improvement is coverage, and the key to coverage is improvement.”  In other words, we will never produce high value, high quality care for our country until everyone has access to that care.  Likewise, unless we produce care that is of the highest quality, universal coverage will be unsustainable.

As for me, I choose to be greatly encouraged today.  The keys are in OUR hands. 

--Tom Braithwaite, M.D., FACP is Chief Quality Officer at Sanford Health in Sioux Falls